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. Thank you Paul, v helpful.

    Re the difficulties, I assume that it’s possibly the ankylosing spondylitis/klebsiella link.

    I got a bad stomach ache from brown rice syrup but I found a source of white rice syrup on Amazon so I’ve ordered it and will feedback – I know that there have been a couple of other posters with similar problems.

    Incidentally, i was thinking about possible reasons for SCD prohibiting pure glucose whilst allowing fruit, and I wonder whether it’s because it seems to always be derived from corn.

    Thnaks again.

  2. Paul,

    My holiday reading has been on milk. From WAPF, 2 raw milk books and another “The Devil in the Milk” concerning A1/A2 milks.

    The raw milk books referenced the same arguments as the raw foodist and vegan/vegetarians in bringing up Howell and enzymes as a justification for raw milk. Food enzymes help digest for several hours before our body’s enzymes kick in. Thus, raw people say 100% raw, and Ron Schmidt says raw milk and fermented veggies (like you).

    Also, the raw milk argument is that raw milk has enzymes and good bacteria to significantly fight bad pathogens where pasteurized cannot and has had significantly worse outbreaks in the last few decades.

    With your fermented vegetables and emphasis on pathogens, I thought you would have an opinion?

    Lastly, the milk devil is A1’s BCM7. Due to a weak link in A1 that A2 does not have, A1’s BCM7 causes inflammation and thus possibly heart disease and others. The only real evidence he provided was an epistimology 90s study of developed nations and A1 versus A2 nations. The probability was the most significant, far more than Keys’. He claims the A2 of France (and southern Europe) versus the northern European nations (and US, Can, Aus) A1 explains the French paradox. Colpo rails against epist. studies, but the highly significant probabilities. Avoiding milk and only advising dairy fats and fermented dairy might be another clue to PHD success as a way to avoid the A1 problem, thoughts?


  3. Hello Paul,

    I am just spitballing here, so bear with me.. I was reading through some older comments and noticed that commenter, Michael, was having some issues with low testosterone. You suggested some basic solutions to raise testosterone as resistance exercise + an anabolic style diet. I have in the past few months taken up a lyle mcdonald/leangains hybrid program (as previously mentioned here). I have noticed a reasonable reduction in body fat and simply look much leaner. However, I have noticed dramatic changes in my cycle. My cycle has always been very long and relatively painless (despite the occasional lower back pain or slight intestinal issue). Recently though my cycle has been much more noticeable as I have experienced extreme breast swelling/tenderness, acne and general body aches. This has gone on for 10-15 days before the onset of the actual period. In addition I have been really craving things I generally do not like, namely seafood. I am curious to know if you think the physical changes have been a result of an increase in testosterone? Is this way off base?

    Another theory is simply elevated stress levels. I find that I don’t know I am under emotional stress until my stomach hurts or my shoulders ache. I would not be surprised if this is stress manifesting itself as an abnormal cycle. If stress is the culprit are you a proponent of the exercise for stress relief solution? I have generally gone on long runs when under stress and I find it allows my brain to clear, but recently was reading the Ray Peat theory of exercise and serotonin being the devil.

    I am sure the shrimp/seafood craving is nothing, but I have always been a firm believer that the body knows what it needs.

    If you do think there is a connection to elevated testosterone and strange menstrual implications… is there any reason this would be unhealthy in the long term or anything I might do to mitigate of the diet/exercise effect?

    As always, thank you.. and Happy New Year!


  4. Paul-

    I’ve been gluten-free since 2001. Gluten-free wasn’t the whole answer, so I went raw foods for a couple of years (w/ egg yolks, some brown rice, rare steak/lamb, and fish), but then moved to New England and had to revamp everything since raw foods and long winters were not for me. And I had children. So we had to figure out another way to make our diet affordable and satisfying for all.

    One thing I noticed was that even brown rice and brown rice products were not good for me. Instead of going with the white rice and all the vitamins it’s sprayed with, I took my traditional foods knowledge and started soaking brown rice for 48 hours in an acidic bath. This made a huge difference in digestibility. But then it went one step further, and I started grinding it and making a sourdough that was fermented for 24-48 hours. I was shocked at how easy to digest, satisfying, and versatile this rice product was.

    I was so happy to see your information on Dr. Mercola’s site (following him since 2003), because with pregnancies and breastfeeding, I noticed *white potatoes* were the single best answer to my carb needs. Everything out there was against it, but I have learned to listen to my body above all over the years. I wanted to see if there was any experimentation being done on brown rice/soured brown rice flour to see how this affects people differently.


    Hi Cassi,

    Soaking and fermenting do detoxify grain toxins, at least partially, so nearly everyone will tolerate brown rice better after it’s been soaked and fermented. Compared to other grains brown rice is already pretty low in toxins, so this is much better than wheat. I think you would have done well with clean white rice too, but congratulations on finding an approach that works.

    White potatoes are also low in toxins if properly handled, thus they are among our “safe starches” and a favorite food on our diet. I’m glad you’ve found the same.

    I’m not aware of much experimentation on variability in tolerance for soaked/fermented brown rice. I would imagine that a few people are probably still sensitive to it, but not many.

    Best, Paul

  5. Lots of great questions. Thank you again for your dedication.

    I’m wondering if you have an opinion of the “Eat Right for Your Blood Type” camp. Some years back I got that book and found it interesting because I am type “O” and the primary recommendations fit my experience — meats and certain vegs are great, no dairy, no grains. Before I ever heard of blood type diets eating this way helped eliminate joint pain and progression of joint distortion. But the details of the diet for type “o” are troublesome. NO dairy — including fermented, yet I am loving my return (since PHD) to old fashioned, nothing added, separating yogurt every morning, as well as my raw cream laden coffee. No citrus, but my smoothie starts with an orange. No strawberries, but that smoothie may include them and how I love them. No cabbage, but my nightly veg juice includes a wedge of cabbage. No avocado (!!), a friend since my youth. No coconut products, but I’m so enjoying this new friend.

    It seems the premise of the diet for type “O” is the “fact” that type “O” folks have an abundance of stomach acid. I was tested many years ago (radio transmitting pH meter attached to a string in my stomach for five hours) and found to have little to no stomach acid. Thus, I try to take it with my larger meals.

    Paul, and others, does anyone believe there is anything to the blood type diet theory?

    Hi Dale,

    I don’t believe there is anything to the blood type diet theory.

    Our book discusses the general evolutionary history. The mammals, who diversified over the last 60 million years, have very little variation in the nutrient needs of their bodies. What varies among the mammals is the nature of their digestive tracts and livers, which transform the foods they eat into the nutrients their bodies need. Different diets, different guts and livers, but the same overall nourishment.

    For humans to require genetically different diets, there would have to be differences in the gut and liver between human populations. Blood types don’t do it. There are some variations in gut structure, but not enough to account for the big dietary differences proposed by the blood type diet.

    Best, Paul

  6. My husband has just been diagnosed with Celiac disease but I don’t see a category for for this specific problem. Is there a reason this has not been addressed?

    Hi Lisa,

    Well, first of all, we recommend eliminating wheat and other gluten-containing grains entirely. That alone will largely fix celiac disease right there. The other part of the cure is improving the gut flora.

    We have a general category of “Bowel disease” under which celiac disease is included. Since bowel diseases often have similar symptoms, it can be hard to know which bowel disease you have at first; and the general approach is similar in most of them. So check out our bowel disease category: http://perfecthealthdiet.com/?cat=47.

    Best, Paul

  7. Hi Paul

    I would appreciate your help with of a section of the book dealing with short fasts. I want to make sure I am getting it right as I would like to try this. The section says “.. a good way to implement short fasting is to confine eating to an 8 hour window each day – say noon to 8.00pm. There is little danger from repeated 16 hour fasts, as long as liver glycogen stores are replenished by eating ~400 calories of starchy carbohydrates during the 8 hour feeding window. (still quoting)…… CAN ANYTHING BE EATEN DURING A SHORT FAST? Yes the key is to avoid carbs and protein, which would diminish the benefits of the fast. But fat and fiber (vegetables) can be eaten” End quote.

    Could you please confirm my interpretation that during the 16 hours “fast” period I could eat any fiber vegetables and any of the healthy fats such as butter, cream, coconut oil etc. So during the fasting period of 16 hours I could have, for instance, a cup of coffee with cream, and/or some fiber vegetables with butter? I presume it would be best not to overdo this eating within the fast.
    Many thanks again

    Hi Kay,

    Eating will alter the nature of a fast, but there is a continuum between a total fast and normal eating, and low-level eating can still retain some of the benefits of a total fast. So you have options.

    There are basically two ways to add food to a fast while retaining many benefits:
    – Make it a protein-sparing fast. This is helpful for long fasts, it makes them more tolerable. Eat some protein but not carbs or fats.
    – Make it a “ketogenic” fast by eating some ketogenic substrates — fiber and short-chain fats — but not carbs or protein. This is generally a good strategy for neurological healing.

    A fiber-and-fats fast is basically a form of ketogenic fast. I would recommend this as a therapeutic strategy against neurological issues, eg migraines, epilepsy, dementia, mood impairment, anxiety, neuropathy, etc.

    If your primary goal is weight loss, and you don’t tolerate a total fast, then either (a) a spoonful of coconut oil when hungry – sort of a Shangri-La Diet strategy – or (b) a bit of protein – protein-sparing modified fast strategy – would be reasonable strategies.

    Hope that helps!

    Best, Paul

  8. Hello Dr. Jaminet,
    There is some key confusion about the Paleo or supposed ‘hunter-gatherer’ diet which I believe a look at our research will easily change your colonial institutional imposed concepts. As you have noted there are some gaps in our knowledge about this period of human history. A key gap has been the erasing of ‘indigenous’ (Latin = ‘self-generating’) knowledge about human history. Indigene Community is devoted to compiling indigenous knowledge from all humanity’s original indigenous ancestors from every place worldwide. http://www.indigenecommunity.info
    1. As ‘exogenous’ (L = ‘other-generated’) displace peoples invade indigenous territories and impose imperial colonial hierarchal governance upon indigenous peoples. The result is that exogenous institutions denigrate and outlaw indigenous culture, association, trade, industry, economy, institutions, culture and even language.
    2. Exogenous people displace indigenous peoples from traditional rich low altitude climates into high mountain refuges. Much of exogenous academic studies about indigenous peoples has been about refugees.
    3. Indigenous peoples worldwide were cultivators of Polyculture Orchards or what the United Nations calls Agro-forestry, and others are recreating in Permaculture and Forest Gardens. Polyculture orchard areas absorb some 92 – 98% of solar energy used to convert this energy into matter through photosynthesis. Root systems descend as deep as the canopy into soil and rock substrates pumping water, minerals and nutrients from deep life colonies along the root systems all being sent to the surface for all animal and plant life. The nut, seed, fruit and green food producing trees, vines, berry bushes, lower nuts, fruit, herbs, vegetables, grains, mushrooms, etc. The UN and other bodies now determine that 3-dimensional indigenous polyculture orchards are 100 times (10,000%) more productive than 2-D (linear) ‘agriculture’ (Latin ‘ager’ = ‘field’). Estimates are that indigenous peoples in temperate and tropical climates would work one hour a day with huge surpluses and stable reliability of abundant food and materials. https://sites.google.com/site/indigenecommunity/design/food-materials-resouces
    4. As indigenous peoples are displaced as refugees, then they turn without choice to ‘animal’ (a vegetable on hooves) sources of nutrients and offer their condolences to these animal ‘kin’. Exogenous peoples are all originally indigenous but have become displaced through the scarcity of ‘agriculture’, inherent war and destruction of the biosphere involved. https://sites.google.com/site/indigenecommunity/design/responsable-health

  9. Paul,

    I found your site today and have been reading over it for hours. I was pointed here from Dr. Mercola’s site. It is fascinating to read your interaction with visitors and I think it’s great. The first article I read was Jaybird’s weight loss report and couldn’t stop reading after that.

    I saw where you lay out a typical day, (a response in your safe starches area) that includes white rice, meat, sauce I assume for the meat, veggies, and some optional dairy or wine. However I see no fruits listed in any of your meals.
    I also see no mention or discussion about freshly made vegetable juices.

    What is your advice about fruit like an apple or orange or pineapple or cantaloupe, also about fresh vegetable juices and how these may or may not fit into your diet plan?


  10. Dear Dr. Jaminet,

    I have just learned about your PHD theory and book and I am very interested to read all about it.

    I may be a little impatient in asking, considering I am yet to receive and read your book however, I can’t help but wonder about where a vegetarian diet fits in with the PHD.

    Is it ok to eat eggs, including their yolks, every day as the one source you recommend in the ‘Meat, Fish & Eggs’ department?

    Also, do you have any opinion on the Blood Group Diet and its evolutionary background? I was considering this diet before stumbling upon yours. Do you believe it could be a waste of time and energy?

    Thank you for your time, Dr. Jaminet. I look forward to hopefully hearing from you.

    Best regards,


  11. Hello Kathryn and Dale

    I have been following the blood type diet more or less since the book came out in the UK many years ago.

    I have tried many diets over the 30 years since my diagnosis of ankylosing spondylitis and BTD/Genotype/SWAMI (until recently) has definitely been more effective than any of the others.

    When I first glanced at the first BTD book in a bookshop, on a friend’s recommendation, I thought it was a load of rubbish based on pseudo-science. Then, a while later, another friend recommended it most emphatically because he had had such good results, so I looked at it again. I found, much to my surprise, that many unlikely-sounding foods, that I had identified a long time previously as making me feel ill and had eliminated from my diet, were in my avoid column eg mangoes, oranges, bananas.

    This persuaded me to give it a go. Some of my digestive problems improved and I felt better enough to stick with it, even though I’ve always felt it was flawed in many respects.

    When the Genotype diet book was published I switched to that and for the last couple of years or so I have been following the SWAMI diet, the most recent development in it. Over the last 9 months I have combined it with Paleo/GAPS/SCD principles, which means that I’m not really doing SWAMI properly, other than excluding my avoid foods, because I’m not eating most of the recommended starches.

    After all this time I am ambivalent about the BTD and its principles, I’ll be as brief as I can.

    I think that Dr d’Adamo does the diet a disservice by not publishing any research, at least not as far as I know, and this makes the diet(s) a fair target for criticism. Also, the semi god-like status given to him by many of his devotees on the BTD forums is a bit off-putting for me and seems to drive away curious questioning (unlike this blog). I don’t think that this is Dr d’Adamo’s doing though, I’ve heard that he is a very lovely man.

    There seem to be a number of misconceptions about BTD, at least ignorance of how it has evolved.

    Genotype and SWAMI have a lot more parameters than just blood type and are also not based solely on Dr D’Adamo’s theory on lectins. I think that the basic BTD is probably too crude and inaccurate to be of much use to many people.

    I also think that it’s a work in progress and time will tell. I have found that there is definitely something to the SWAMI diet, even though it may be incomplete and sometimes inaccurate. I have a list of inflammatory and anti-inflammatory foods that would probably look ridiculous to most people eg cod anti-inflammatory, haddock inflammatory. But I have found this list of inflammatory foods to be accurate eg I have on occasion eaten haddock thinking it was cod and had a flare-up of inflammation ie it couldn’t have been psychosomatic.

    However, I would add that, in my experience, people usually feel better when they switch from a high-junk diet to almost any other diet. Even switching from one low-junk diet to another can produce an improvement, maybe because, as Paul says, it’s the dose that makes the poison, so it’s always at least temporarily beneficial to stop regularly eating something that’s toxic, even if you’re inadvertently switching to another set of toxins instead.

    To add to the confusion about how to evaluate a diet, I think that human physiology is able to compensate and maintain some kind of balance for an amazingly long time before the ill effects of a particular diet may manifest.

    Out of all the stuff that I’ve read about diet over the years, and all the justification for eating or not eating certain foods, only one thing seems to be completely and utterly self-evident , beyond question – humans have to be physiologically able to eat meat and fish. So any arguments for vegetarianism and veganism based purely on human physiology, as opposed to ethics or personal preference, seem to me to be to be fallacious.

  12. please elaborate why lentils, bean, and all grains should be eliminated when much of the word is restricted by religious and financial reasons for not being being able to eat meat and dairy product. I truly would like to move to this kind of eating but have cultural restrictions. Can you please help.

    Hi Felicia,

    First, we don’t dictate what you eat but rather try to inform you what the health consequences are of eating different foods, so that you can design your own diet. Balancing finances, religious or cultural requirements, and individual tastes and food preferences with health considerations is ultimately something everyone needs to do.

    We recommend eliminating those “unsafe starches” because (a) on a relatively low-carb diet like ours, you don’t need to eat a huge variety of starch sources, and (b) alternatives such as rice and potatoes and taro are safer/healthier.

    However, beans and lentils are fairly safe if they are soaked/sprouted overnight and then thoroughly cooked. Traditional cooking methods were effective detoxification programs. Most modern people don’t have time for that, but if you want to diversify your food sources to include these starches then I would try to learn and make time for traditional cooking methods.

    Best, Paul

  13. I would love for you to elaborate a bit more on the steps you took to get rid of your rosacea. I’ve been able to get mine under control (most of the time) with herbs from my acupuncturist, but I would love to get to the root cause and get rid of it once and for all. Thank you in advance!

    Hi Vicki,

    It’s a complex ailment and I can’t say I fully understand it, but I’m planning a series on it soon to share my perspective, probably following the obesity series. Be sure to tend to oral hygiene and gut health – see our bowel disease series.

    Best, Paul

  14. Hi Paul,

    Do you have any good recommendations for studies to read regarding MSG as being harmful?

    I’m trying to read and understand a couple different topics right now, one of which is GAD and GAD antibodies. I was wondering if there is any connection between GAD and MSG? At this point, I’m not educated enough about the whole thing to even answer as to what kind of connection I’m looking for, but in any case, I guess I’m always wondering about the type 1 diabetes. I learned how pancreatic beta cells have GAD molecules, as do a strain of the coxsackie virus (hence the theory that coxsackie virus may play a part in development of type 1 diabetes by the body forming GAD antibodies that mistakenly attack the pancreatic cells in an effort to get rid of the virus). I was also trying to find out if cow’s milk has GAD molecules? I haven’t found that answer yet. And since I’ve known that MSG seriously debilitates me– migraine, stiff neck near base of my skull, extreme nausea, light- sensitive– I was wondering because of the similar root (glutamic acid) if there was any connection?

    Do our bodies generally view MSG as harmful and we could create antibodies to it? Or do our bodies generally accept it? Sorry for all the random questions … I don’t know if you have any of this in your book, but we did just (finally!) order your book, so I will look for any info there too. I haven’t read through this entire site yet… are there any areas where you talk about MSG? I already avoid it like the plague, but wanted to know if you had done any research in that area yet.

    Thank you kindly for your time!

    Hi KH,

    Wikipedia has a good introduction to glutamic acid decarboxylase (GAD) and the diseases associated with its deficiency, sometimes due to autoimmunity against it: http://en.wikipedia.org/wiki/Glutamate_decarboxylase.

    I haven’t looked into the pathogens that trigger autoimmunity against GAD, how it impacts these diseases, or connections to MSG. It does sound like an interesting pathway to research, so thank you for introducing me to it. I don’t believe there are antibodies to MSG, but GAD removes excess glutamate and so any deficiency of GAD causes an excess of glutamate which is neurotoxic, and eating MSG would tend to exacerbate that glutamate excess. So people with GAD antibodies would be unusually sensitive to MSG.

    Best, Paul

  15. Hi Paul,
    What is your opinion on fresh juices (juicing) and green smoothies.

    Hi JC,

    I have no objection to them, if the quantity of fruits and vegetables used is comparable to that that would normally be eaten (eg, ~1 lb per day, 2 lb at most). But then I wonder, why not just eat them as solid foods? If the purpose of juicing is to be able to tolerate super-normal quantities, then I would say that there is no evidence that huge quantities of vegetables are beneficial, and they might be harmful, since all plants have toxins and the dose makes the poison.

    Best, Paul

  16. Antonio Pitaguari

    Dear Paul,

    I found your amazing book through Mercola´s website.

    I am from Brazil and would be interested in translating it into Portuguese.

    Who should I contact?

    Thank you,


    Hi Antonio,

    Thanks for your interest in creating a translation. However, the bigger problem is finding a publisher for a Portuguese version. I could publish a Portuguese edition on Kindle, but I would have no idea how to get a printed Portuguese edition into bookstores or online distribution outlets. My preference would be to find a Portuguese or Brazilian publisher and let them handle the translation.

    If you have any insight into Portuguese-language publishing, send me an email so we can discuss.

    Best, Paul

  17. Hi Paul,

    Saw your interview with Mercola, and just bought the book today. It’s great so far. The diet is actually very close to what I’ve been doing over the past six months or so to battle my rosacea. I have a couple of questions:

    * I’ve seen some improvement in rosacea flare ups, and for months I’ve been trying to correlate them with certain foods, but it seems to be almost completely random, which is extremely frustrating. How does the PHD specifically eliminate rosacea?

    * I have tried SCD, GAPS, and Body Ecology diet in the past, thinking that candida is at the core of the issue, and that eliminating sugars is the answer. How can PHD be better than these diets if I’m allowed to feed the yeast with fruits?

    * I’m in my late 30’s. My skin issues have been with me for over 10 years. Do you have any general benchmarks for me insofar as a timeline in which I should see results?

    * You noted that in your personal struggle, you had to tweak your diet for a bacterial issue and ended up with a rosacea flare. Was that candida related? Does this mean that you can never actually totally ‘cure’ yourself of these types of issues? I was under the impression that once you healed and re-established a healthy ecology, you were not as susceptible to flares.

    Thanks for a wonderful book, and all the research you’ve pulled together for us.


    Hi Marc,

    First, I believe that rosacea is infectious in origin and just following PHD generally tends to cause it to fade, but may not eliminate the infection so circumstances may cause the rosacea to flare from time to time.

    I do think that Candida is part of the equation in rosacea — I suspect a co-infection of Candida with bacteria such as Streptococcus, which can share biofilms together and reinforce each other. The best anti-Candida diet is generally low in fructose but has a significant amount of glucose. Glucose is needed for anti-Candida immunity and to suppress ketosis which benefits Candida.

    Rosacea is curable, but a cure may require treating the infections with antimicrobial medicines. I used fluconazole and Chinese herbs for Candida, and antibiotics for bacteria. Of course I was treating other problems besides rosacea. Then you have to restore a more healthful gut flora. That can take some time. If you get a flare before you establish a new flora, then you may need antimicrobials again. After antibiotics it can take several years for gut flora to stabilize. So some patience may be needed. But if you maintain vitamin D levels and eat a good diet, you can hope for steady improvement.

    Best, Paul

  18. Dear Dr. Paul,

    I am so excited about your Perfect Health Diet! I saw you on Dr. Mercola’s newsletter, downloaded your book onto my kindle and have already bought some white rice and potatoes! What caught my eye (no pun intended) was your statement that a low carb diet can cause dry eye. I have ‘severe’ dry eye and haven’t been able to figure out why. I actually have been eating pretty close to the Perfect Diet for years now….in fact I LOVE coconut oil and recommend it to my customers (I work in a health food store) I added flaxseed oil….no change in my eyes. But I realize that my carbs have only been coming from veggies…practically no starch at all. I am hoping the white rice and potatoes will help. I have lots of question, but I will ask this one first. Occasionally, I will eat a sandwich made with sprouted spelt bread…believing that sprouted grains are actually healthy. Am I wrong?

    Hi Sally,

    Welcome! I’m delighted you’ve found us. Adding the starches and some vitamin C will probably be enough for your eyes.

    Re the spelt bread, sprouting does reduce (but not eliminate) toxicity of grains. Spelt itself is a hybrid of wheat and goat grass that has all the chromosomes of both species (http://en.wikipedia.org/wiki/Spelt). This means it has all the toxins of both species. I would not count on it being a low-toxicity food. I think it would be much safer to stick to gluten-free breads made with rice flour, potato starch, and tapioca starch, such as Udi’s. They don’t taste quite as good but are much healthier.

    Best, Paul

  19. Hello Paul

    Regarding your answer to the question about juicing fruit and veg, is it the case that the glucose in the juice is available to the system as part of the glucose requirement that you talk about (200 -300 calories) as opposed to its being used for the digestion of the whole fruit/vegetable, which obviously includes the cellulose pulp.

    I am thinking here of what you’ve said about the reason for the carbs in non-starch veg not counting towards the daily carb requirement because their glucose content is required for their digestion and therefore isn’t available to the rest of the body.

    Or have I completely got the wrong end of the stick here?

    I was wondering whether vegetable juices could be useful for people like me whose symptoms are aggravated by starches, incl the safe ones, and are therefore trying to find the least worst alternative that optimises glucose intake whilst minimising fructose intake.

    Thank you.

    Hi Frances,

    Good question. If juicing does make the vegetables more digestible it might increase the net glucose contribution from vegetables. I haven’t seen data quantifying it however. In any case, the amount of calories in most vegetables is small enough that I would still recommend getting most carb calories elsewhere.

    One possible solution to improve the glucose:fructose ratio while avoiding starches would be to add rice syrup or tapioca syrup to juiced vegetables or fruits, or to smoothies of some kind.

    Best, Paul

  20. Hi Paul

    Thank you.
    I shall report back when my clear (as opposed to brown) rice syrup arrives.

    I’m also experimenting with a congee, sushi rice cooked for many hours in a large quantity of water so that it forms almost a porridge, to see if I can tolerate that without getting more inflammation.

    I assume that when my leaky gut is fixed that I won’t have the same problem with starch aggravating AS symptoms but maybe that’s over-optimistic.

  21. Paul,

    Love the site, finding it was eye-opening. It seems like I come here just about everyday for something different. Waiting for the book via Amazon right now.

    Just had a question on physical fitness. Does the Perfect Health Diet change much depending on how physically active you are? If so, what would be the specific changes? I do resistance training (weight lifting) 3 or 4 days a week and am generally active during the week.

    Also, do you have a general recommendation on fitness in general? Do you find something like Mark Sisson’s approach to be a smart one?

  22. So much information. I appreciate the input of so many, and thank you to those who commented about the blood type diet.

    Have not purchased a kitchen scale yet. Is there a recommendation?

    With regard to bread, it is tough to abandon the memory of this genuine “comfort food.” Paul’s comments to Sally prompt this response: I was enjoying Udi’s, then took a recent look at ingredients, which list as:

    A few problems, such as canola oil, corn starch, xanthun gum (Sarah Pope cautions against this), cane juice/sugar. Sunflower oil? Don’t know.

    I absolutely avoid standard veg oils. So, looked and found a bread with this list of ingredients:

    Organic Millet Flour, Brown Rice Flour, Water, Aluminum Free Baking Powder, Sea Salt, Cultured Brown Rice Flour,Ascorbic Acid

    Before I learned about millet being a problem, I was very thankful for this bread. In fact, the ingredient list is hard to believe — no oil, no sweetener. But millet is high on the list of foods to avoid. So, this one is a “no.”

    This particular bakery produces a cinnamon raisin bread that is wonderful, but forbidden because of millet. Ingredients listed are: Organic Millet Flour, Brown Rice Flour, Water Aluminum Free Baking Powder, Sea Salt, Cinnamon Spice, Olive Oil, Raisins.

    My experience with spelt. Fell crazy in love with this stuff, since wheat caused joint pain and spelt caused none. Then one day, my bowel emptied itself with all manner of violence while in a restroom in the Gap store as I traveled by bus through the Bay Area. (Sorry for the visual) Thought it might be sandwich contents that had gone bad. No, it was the spelt. After a few months of very peaceful coexistence, my body rejected the stuff, resoundingly. When I returned from that trip, still assuming the problem was the contents of the sandwich, I had a spelt muffin one morning. Again, violent evacuation. Charcoal bailed me out, but a few more trials and I was convinced, so I do not touch spelt ever. As I understand celiac disease, this reaction is what those folks experience from eating wheat.

    Anyone able to convince me that Udi’s is a good way to go?

  23. Hi Paul,
    Thank you for the response about GAD antibodies. I think I will try to get tested to see if I have GAD antibodies (I believe they tested me when I was first diagnosed with type 1 diabetes 10 years ago, but I don’t remember…).

    About the MSG… Good point about the glutamate excess, makes sense. I try very hard to avoid MSG (which I’ve found is difficult to do) because of how horrible it makes me feel. For anyone else out there who might be sensitive to it, though most of you probably already know this, beware of possible disguised MSG in the ingredient list under names like “natural flavor.” Even some of the tea we have lists “natural flavors” so I try to avoid those. I did get a migraine yesterday afternoon and was wondering what on earth did I ingest?? But going through everything I had eaten or drank up to that point and the night before, I found nothing new that I had not been eating/ drinking the past few days, EXCEPT for the Masala tea I had mid-morning. I drank it plain– no cream or sugar. So, I looked at the box of tea and here were the ingredients: black tea, natural flavors (this was a newly opened box). I can’t really prove anything there, but the nausea and intense headache was enough to convince me. When I get brave again, I’ll test it out and see if it happens again when I drink it. (other black tea doesn’t cause this, but I’ll test that again too, but not just yet.)

    Does anyone have any input on Carageenan? I just looked it up on wikipedia and if you read all the way down to the bottom, they mention that studies have linked it to intestinal inflammation, and some implication related to Crohn’s Disease (I have one older brother who has had Crohn’s for about 25 or 30 years). Anyway, I went to look carageenan up this morning because, after drinking my morning coffee with a combination of whole goat’s milk (not raw) and organic heavy cream (cow; no protein)– I was trying to make my own Half&Half without the protein from the cow’s milk, but I haven’t found any goat’s milk heavy cream– anyway, I got pains in my lower intestinal area, followed by diarrhea. I will continue to test this out to find out what is going on, but for now this is what I’ve concluded… Since I had the goat’s milk a few times before without problems, I ruled that out (for now). (Goat’s Milk ingredients: Goat Milk, Vitamin D3.) But, the heavy cream is new (bought it yesterday). So, I looked at ingredient list of the heavy cream. Ingredients: Organic Grade A cream (milk), carageenan. So, I looked up carageenan. So, my thought is that the carageenan might cause or aggravate some inflammation in my intestinal track. Does anyone else have any thoughts on this? Paul, are there any pages here that talk about it?

    The reason for trying the goat milk is due to the cow’s milk variation theory about the A1 vs. A2 type milks. Being that I already have type 1 diabetes, an older brother also has type 1 diabetes and a different brother has the Crohn’s, I’m very interested/ concerned about the possibility of the cow’s milk theory. I don’t know, but I think I should test it out for myself since my BM has never really been consistent and diarrhea seems to be common enough for me, but never painful. The problem is that I haven’t really been paying attention much in that regard (probably in fact because it never was painful so I didnt pay much attention); now I realize I should have been.

    Anyway, sorry to go on so much… any input is certainly very appreciated and welcome.
    Thanks again Paul and Shiou-ching!

    Hi KH,

    Carrageenan can definitely cause problems.

    We haven’t posted on it but there have been several discussions in the comments:

    http://perfecthealthdiet.com/?p=1788#comment-13100 and subsequent comments.

    http://perfecthealthdiet.com/?p=4650#comment-30405 and subsequent comments.

    Best, Paul

  24. Hi Paul,

    I’ve been on a diet very similar to yours for almost a year now. I am very active (intense physical activity 4-6 times per week), I eat very few starchy carbs (my carbs come from vegetables) and almost no sugar, yet my A1C is ‘elevated’ (5.8%). My LDL and total cholesterol are a bit high (130/235 mg/dL), and my cortisol was a bit high (though I can’t find it in the report).

    Are there any specific things I should adjust for the A1C and cholesterol? Given my diet and fitness level, those numbers surprised me a bit.


    Hi Marc,

    I consider your cholesterol numbers normal, close to the optimum. The HbA1c is slightly higher than the optimum but not unusually so. For that I would suggest that you donate blood regularly and supplement micronutrients involved in glucose regulation; our standard recommendations are a good set, and Stephan Guyenet had a recent post on this, I’ll be posting a discussion in a few months as part of the obesity series.

    Best, Paul

  25. Thanks Paul,

    the kids take Nature’s Plus Source of Life Animal Parade Gold, which is the only one I found that has minerals, K2 and probiotics. The only things I would change in it would be cyanocobalamin and Mg, the amount of Mg in it is negligible.

    I don’t know if ‘aminoate complex’ is a good way to deliver minerals.

    They do take 1000 iu vit D and iodine every day.

    Hi simona,

    “Aminoate complex” is good. Amino acid chelates are the natural way to get minerals.

    You can supplement magnesium separately, or put epsom salt in their baths. The cyanide from that much B12 is trivial, shouldn’t be an issue.

    Best, Paul

  26. Hi Paul.

    A quick question regarding bananas. On the SCD it is recommended that bananas are only eaten when they are really ripe (with brown spots on the skin) as this is when most of the starches have converted to sugars.

    If this is the case then, for the PHD, would it be better to eat them less ripe thus giving you the glucose from the starch but less of the fructose?

    Is any of this even true!?


    Hi HH,

    Well, first of all unless you have a bowel disease it’s not going to matter, so I would eat the banana in the form that you like.

    If you do have a bowel disease then I would suggest experimentation to see what you tolerate best. The riper bananas I think have more fructose, the earlier bananas more fiber, so it could go either way depending on the type of bowel dysbiosis.

    Best, Paul

  27. @Lindsay – In my own experience and based on what I’ve read, painful periods follow an ovulatory cycle (as opposed to an anovulatory cycle. I quickly looked through my book “Fertility, Cycles and Nutrition” by Marilyn Shannon (which I highly recommend) to see if she mentioned anything on testosterone being the cause of your pain. I didn’t see anything. Instead she says that “the interplay of estrogen and progesterone, especially the drop in progesterone shortly before the period begins, is involved in the pain” (86).

    As for sore breasts, do you drink coffee/tea? Caffeine is usually the culprit for that one.

  28. Hi Paul,
    I cough all the time. I can’t even laugh without coughing. I’ve had a chest X-ray–all normal. My doctor told me I am allergic to many things, cats, dust, mold and I do have a cat. I have learned to just live with it but since discovering this site I feel hopeful. Is there anything you can suggest. I’ve been improving my diet and getting closer to the PHD way of eating but I have not completely purchased all of the supplements yet–doing a few at a time. Could it be a nutrient that I’m missing.
    A million thanks for all you do.

    Hi Isa,

    Nutrients do matter. Vitamin D and its pals vitamins A & K2 are most important for immune normalization, so make sure vitamin D levels are optimal (serum 25OHD near 40 ng/ml = 100 nmol/l). Vitamin C matters.

    You might try detox aids to help clear toxins. Glutathione for the liver, bile supports (vitamin C, taurine, cholesterol from egg yolks), and charcoal and/or chlorella might be worth a try. Eat plenty of salt and drink plenty of water.

    I don’t know what’s causing the cough but these seem like good places to start.

    Best, Paul

  29. Hi Paul

    Is there ever a case for supplemental omega-6?

    My 59 year old sister has Chronic Fatigue Syndrome. She eats the std “healthy” diet – grains (but low in wheat), legumes, fruit , veggies, meat, yoghurt and low saturated fat. Since her teens she has had from time to time small scaley patches that resolve with omega-6 supplementation. Fish oil makes them worse. Recently this has become much worse in the form of eczema. At the present time she is taking 2 tablespoons of organic cold-pressed safflower oil 4X a day to control it. If she misses a dose her arms and face rapidly develop eczema which in a short time opens up and oozes. When this happens, within 3 hours of a dose she can visibly see the eczema healing and returning to almost normal. She has no diarrhea and still has dry skin on unaffected parts, despite this medium-term high dose of oil. Do you know what may be happening here?

    I read in Nora Gedgaudas’ book Primal Body, Primal Mind of a genetic condition called Pyroluria which benefits from omega-6 supplementation. My sister hasn’t been tested for this but seems an unlikely candidate as she exhibits few of the characteristics of the disease.

    My sister quotes Adelle Davis who apparently cured a very young boy of severe “incurable” eczema by giving him very high doses of soya bean oil. The cause of his problem, according to Adelle Davis, was very low omega-6 intake by the mother during pregnancy. My sister was born 2 months prem.

    I would like to encourage her to try the PHD for her CFS but it is hard when, in her eyes, one of the basic principles (reduce omega-6 intake) seems so wrong for her.

    Would really value your thoughts on this one, Paul.

    Kind Regards

    Hi Joan,

    If the supplemental safflower oil is helping then I’d stick with it for a bit, but I’d try to figure out what the underlying pathology is that’s causing a need for extra omega-6, and fix that. Then cut the omega-6.

    My guess is that there is a high level of oxidative stress which is diminishing AA levels, and the safflower oil makes more arachidonic acid and relieves the problem. So the strategy I would try first is (a) supplementing antioxidants, eg zinc, copper, selenium, vitamin C, vitamin E (mixed tocopherols / tocotrienols), glutathione, alpha lipoic acid; and (b) treating any infections. Also, get serum 25OHD levels tested and normalize vitamin D/A/K status.

    I would guess that there is an underlying infection which is causing the CFS as well as the omega-6 issues but I understand those are hard to diagnose and treat. She needs to find a doctor who will aggressively pursue diagnosis of infectious disease possibilities. It’s probably not viral if it’s causing oxidation so it should be diagnosable. A stool test may be a good place to start.

    Best, Paul

    PS – Please let me know how your sister’s case develops, it’s interesting.

  30. @Ashley–I appreciate the thoughts. I will have to read the book.. sounds interesting. I am wondering what one can do to modulate the drop in progesterone that causes the pain. Sometimes I feel like my cycle gets weirder with age… almost like my body is saying, “C’mon, have a kid already!”

    And yes to the caffeine connection.. but I have always been a heavy caffeine consumer so that does not really explain the recent surge in weird symptoms. However, as I briefly mentioned in my last post I think it may be stress related. I have also recently had flare ups of what looks like mild rosacea. AAHHH! I have been under extreme stress.. this is the only connection I can make. So who knows where to go from here. I suppose I’ll just keep on digging.

  31. Thank you, Paul for your fast and detailed response. I’ll pass all that onto my sister and will definitely let you know how things progress.

    Thanks for all your hard work. What I’ve learnt from this blogsite has helped me immensely with my Crohn’s disease. At some stage I’ll post on your results thread but at present it’s still a “work in progress” as I process and apply all the information available here.

    With Grateful Thanks

    Hi Joan,

    Best of luck to you and your sister. I’m looking forward to getting your results story when you’re ready!

    Best, Paul

  32. Hey Paul,

    I woke up to UTI yesterday and after some googling, I settled on the following(inspired by your agutak recipe): 1 cup of fresh cranberries + 1 T coconut oil (anti-bacterial) + juice of 1/2 lemon (Vit-C), microwaved to a mush. I ate them along with an orange for extra vitamin C. I also took 6 probiotics pills. Mid-morning I ate a bowl of cranberries + 15g of coconut butter microwaved to a mush and 3 more probiotics pills. I took 5 more probiotics throughout the day. I also avoided coffee and tea all day. This seems to alleviate the pain and almost got rid of the infection.

    I want to hear your thought on my experience and if you have any better recommendations for treating UTI. Thanks!

    Hi p.wen,

    You seem to have done a good job of finding foods and probiotics that work against a UTI. Personally, if it doesn’t go away I would turn to antibiotics.

    Best, Paul

  33. Paul,

    Thanks for answering the banana question. I do have a bowel disease (UC)and do struggle with fibre. I also have candida issues so am trying to avoid too much fructose. Medium-ripe bananas look like the best way forward!

  34. I have a question. After much research I’m beginning to think I may have Acute Intermittent Porphyria. I know it sounds incredulous but I’m quite serious. I was wanting to buy and try the Perfect Health Diet to help me with my health complaints but recently read that low carb can bring on attacks or make porphyria worse. I find low carb; and that means predominantly meat and vege with one meal based on sourfermented rice bread so I’m guessing by weight about 20% fermenred rice the rest meat vege and fats gives me so much more energy my fibromyalgia is drastically reduced and insomnia disappears, I need way less sleep am not grumpy and irratible anymore and lose weight BUT my attacks of abdominal pain become more frequent. I have discovered that very sweet apple and mango juice shortens and relieves the attacks taken in large quantities. If I was diagnosed with porphyria which has been shown to be worse on low carb diets how would I best implement the Perfect Health Diet. Thanks.

    Hi Cathy,

    Acute Intermittent Porphyria is a genetic disorder so you might consider genetic testing, eg from 23andme.com, to be sure.

    Porphyria can also arise as a die-off effect from some infections, and infections are the likely cause of fibromyalgia. So this could be a good sign, of progress against an infection. My friends at http://cpnhelp.org have anti-porphyria suggestions at http://cpnhelp.org/reactions_and_remedies, which are:
    — Glucose 3-6 grams at a time until symptoms are relieved,
    — Fat-soluble detox aids such as activated charcoal (12 capsules taken at least 1.5-2 hours before and after eating or other medications), bentonite clay, or Questran/cholestyramine.
    — Cimetidine 400-800mg daily is said to reduce certain porphyrins in the bloodstream.
    — Propanalol is said to limit symptoms like anxiety, rapid heart rate, and autonomic arousal.
    — A vitamin C flush (http://vitamins-today.com/c_flush.html) may help.

    I have no experience with any of these steps, I’m just passing along what they say.

    I think 20-30% carbs is perfect, I wouldn’t deviate from that just for porphyria. Try these other treatments first.

    Best, Paul

  35. Hi Paul

    I have two questions. Since embarking of the diet I have found I have more energy, but almost too much – I am almost hyperactive – a friend even commented that I seemed “hyper” and do feel a bit that way. What could be the explanation for that? However balance, it is better than feeling tired all the time!

    Secondly, I wondered if there would be any harm in eating only two main meals per day. I often do not feel like eating early breakfast, and would prefer to eat a light meal around 11.00am – usually made with eggs with some greens. Then mid afternoon snack on nuts or similar and a coffee with cream, and in the evening have protein with vegetables and potatoes/rice, and sometimes fruit with cream, with a handful of nuts (usually macadamias) as a later snack.

    My question is, am I starving my body of essential “fuel” when it might be needed first thing in the morning and disturbing my insulin metabolism by not eating breakfast? I am currently eating three meals starting with a good breakfast as per your book, but would like to cut back as described.

    I find the diet is perfect for me, but need to fine tune it a bit with timings based on your advice.

    Many thanks again

    Hi Kay,

    To answer your second question first, by all means, eat 2 meals a day if you like that. That’s what I do. I usually don’t eat until noon. This is actually beneficial, I think – it is called “intermittent fasting” and should promote longevity and immunity to bacterial and viral infections of the central nervous system, which are probably responsible for dementia, Parkinson’s, and other diseases of aging.

    The first question is more puzzling. Are you taking the supplements? Did you start with a high dose of iodine? Hyperthyroidism could be a possibility. It’s important to start iodine with a very low dose and build up very slowly.

    Is it possible that your “hyperactivity” is actually normal, you’re just used to being tired? Are you having trouble sleeping?

    I guess I’d say try the fasting and follow our supplement plan more carefully and see if the hyperactivity goes away.

    Best, Paul

  36. Paul,

    We have just become aware of the PHD and are working our way through your book (Kindle as Amazon projected late Jan. – Feb. delivery of the book) and in our reading we’ve encountered several recommendations we’d like clarified.

    The first question pertains to pork consumption –– we purchase locally –– from same the farm as our pastured turkeys, chickens and eggs. The pork too is pastured, heritage pork and is harvested in a humane manner. It is butchered, smoked (bacon ham etc) locally as well. We have rendered (water method) a dozen pints of pure white lard. Is there a problem with antibiotic-free, hormone-free grass fed pork products (no grains) as a part of our diet?

    Question two: We have recently moved from the American Southwest where many of the local foods became staples in our diet. The more research we’ve done the less we like the process and ingredients in some of those foods. A basic rule in our kitchen is “Do Not Eat Food with Labels.” We have very little in the way of processed food in our pantry. If it’s there and it’s processed we put it up in jars, Cryo-Vac in the freezer or have dried it and are storing it for rehydration. We are fortunate as that is how we were raised. So the food in question is corn.

    We (before we found the PHD) purchased a quantity of organic, non-GMO field corn. This is just dried corn simply sloughed off the cob. With this corn we will slake it with calcium hydroxide and then use it in several different ways. The yellow slaked corn will be used to make our masa for tortillas and tamales both of which are combined with lard and then in the case of the tamale –– steamed –– and for the tortilla –– slow toasted on the comal or griddle.

    The white corn is also slaked in the same manner but it produces a different product –– posole. We use the posole in two different recipes – one is to take the swollen (think hominy) corn and bring it to a simmer and add to it fresh crushed garlic and chopped green chile and serve in a bowl with a poached egg and a dollop of organic, grass fed, raw milk sour cream on top. The second method of using the white variety is in a variation of the Mexican menudo soup. We prep, simmer and render beef tendon and beef tripe into small tender morsels of collagen mixed with the posole. This version of red chile is the puree of the rehydrated Ancho chile which provides another version of chile-based vitamin C consumption along with the collagen and corn.

    As neither of these processes involve high-heat processing and we are careful to select only non-GMO organic corn (we have our own heritage seed for next season’s corn) is there a problem with this in our diet with a frequency of once a week?

    We look forward to your clarification.

    Hi Stanley,

    Your pork sounds great! Certainly a good food.

    The slaking method you are using does detoxify corn. (See http://en.wikipedia.org/wiki/Nixtamalization). Like soaking/sprouting/fermenting of legumes before thorough cooking, it’s possible but not guaranteed these detoxification methods make the corn safe. Research is inadequate to tell us precisely how safe these foods are, so in the end it’s a judgment call. I can’t make a definite assertion but I can say that you are eating healthier than nearly all Americans.

    Best, Paul

  37. Hi Paul,

    I followed your advice to test vit D and my level was 24. So first, thanks for the good advice! Second, I have a question about maintenance. I supplemented 5,000 IU D3 for about 5 weeks and retested last week to find that my level is now 51.5. How much supplemental D3 should I take to maintain this level (or even let it drop a tiny bit closer to your recommended amount)? I don’t get much sun exposure. And, I think I have a chronic infection that I’m chasing down with stool tests. Perhaps this means my D should be on the high optimal side?

    Third, do you think it’s necessary to get tested again to be sure my maintenance plan is working?

    Do you think it’s possible to get enough K2 by eating a couple tablespoons of (supposedly – I distrust corporate food claims) pastured butter a day, or would supplementation be better? I don’t like the taste of ghee, though I understand it may be a better source of K2, and I eat little other dairy.

    Thanks again! I feel like I’m slowly, stealthily creeping up on perfect health. I’ll get there when it least expects it. 🙂

    Hi Mal,

    Usually, 4000 IU/day will produce an optimal serum level even in those who get no sun exposure at all. So 5000 IU may a bit much for long-term use. I typically do 2500 IU to 4000 IU during the winter and none during the summer, but I try to get sun exposure.

    Re testing, you have to test a little to bracket the appropriate supplementation range — I think you’ve found that 5000 IU is a bit too much — but once you have a good sense, there’s no need to keep testing. I haven’t had mine tested in several years.

    There’s nothing particularly scary about 51 ng/ml, but if you can raise it that high, there’s a chance that continued intake of 5000 IU/day would raise it further, and you might get to dangerous levels.

    With vitamin K, most of the value is from the first 100 mcg/day, so eating K-rich foods like pastured butter and fermented plant foods will provide most of the value of supplementation.

    Best, Paul

  38. Paul,
    First, I must admit I’ve only recently come across your website and diet theory, so still have quite a bit of reading to do. However, I am hoping you can chime in on my current situation. I have had 7+ years of IBS symptoms (mainly incredible distention immediately after meals that remains for quite some time). I did the GAPS diet for about 3 months, only to have my symptoms worsen ( which I contribute to the massive amounts of probiotics). Two weeks ago I was so fed up I cut out absolutely everything from my diet except meat, eggs, and fat. I feel wonderful. My stomach is content, no bloating, no distention, etc, etc. Every time I try to add back in veggies my symptoms return. How do I progress from here? I read your posts about the dangers of VLC (which obviously I’m currently in ketosis with on 5 or so grams of carbs from eggs/day), and would like to get back to a PHD style of eating…but not back to the horrible symptoms. It seems I cannot handle any fiber or carbs at all. I’ve always though my symptoms were SIBO, or some type of overgrowth of pathogens. Any advice on how to progress so I can tolerate more foods?

    Hi Kate,

    First, congratulations, you’ve made real progress! And welcome to our site.

    So you know you have an infection with one or more carb-dependent pathogens. It’s likely the pathogens are bacteria. So the issue is, how can you clear the infection and enable healthy probiotic bacteria to repopulate your gut.

    You can read our bowel disease category for an overview of possible therapies: http://perfecthealthdiet.com/?cat=47.

    In your case, since it sounds bacterial, antibiotics are probably the most plausible therapy, along with eating fermented vegetables, yogurt, and probiotics. Introduce the fermented vegetables in very low doses, but eat them daily and drink the liquid brine they ferment in. However, the systematic approach would be to start by getting a stool analysis to see if it can identify specific pathogens. I usually recommend this one: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology. Once you know the pathogens, doctors can advise on therapies.

    Another possible therapy to consider is a fecal transplant. I’ve blogged about those.

    In addition to the fermented vegetables, try rice syrup or tapioca syrup as glucose sources; these are the most likely to be tolerable for you. If those don’t work, stay zero-carb and add coconut oil or MCT oil and extra protein to your diet; the oils will help your liver generate ketones, and protein will help avert glucose or protein deficiencies.

    Be sure to optimize vitamin D with its partners A and K2, and take other desirable supplements such as vitamin C.

    Best, Paul

  39. Hi Paul-
    Does donating blood possibly compromise longevity,as in using up stem cells?…Or does the body actually replenish stem cells?…I donate 3-4 times per year,and had not thought much about it until Robb Wolf brought up the possibility in one of his podcast.
    Thank you for any info you may be able to give.

    Hi John,

    Hmmm, good question. I also donate blood about that frequently.

    I have no knowledge, so will just guess. My guess is that stem cell aging is predominantly due to degradation and differentiation (loss of stem cell characteristics) rather than the loss of stem cells from blood donation or wounds. Stem cells can proliferate/multiply and the body probably tries to maintain their populations. So I would expect that you need to be concerned about their health rather than their number — if they are healthy, they’ll restore their numbers themselves. If they are unhealthy, you may lose them or leave them and their descendants permanently damaged.

    Best, Paul

  40. Hi,
    I’ve read the post about hypothyroidism and depression. But what about someone with hypothyroidism and mental health disorder? How many carbs would you recommend? 50 or 100 grams per day?

    Hi JP,

    It’s impossible to give a specific recommendation for a disease of unknown cause. Our book is about our general strategy in such cases: implement the basic diet and nutritional program, then experiment. For mental health conditions, it’s usually a good idea to experiment with ketogenic (lower-carb, ketone-producing) diets. Antibiotics might be something to consider. Whatever experiments are tried, it’s usually best to eat the basic diet for a few months first, to improve health and have a baseline against which to evaluate the experiments.

    Best, Paul

  41. Hi Paul,

    I was looking for anti-candida toothpaste ideas through the different comments in your website and the GAPS diet FAQ section and found the following. In the GAPS FAQ they recommend using baking soda because “yeast thrives in acidic environments”. In one of the comments you mentioned that you make your toothpaste by mixing vinegar with turmeric. Do you use this mix for Candida or does it have another purpose?

    On the other hand, in the GAPS FAQ, as a general guideline, they recommend using cold pressed olive oil as a toothpaste. I find this recommendation more in line with the Anti-Candida steps suggested in your weblog. Could you please elaborate on this one?

    Thanks Paul

    Juan Camilo

    Hi Juan,

    Cold-pressed olive oil as a toothpaste is a great idea, I wish I had thought of that.

    In general acids inhibit fungal growth, thus their use as food preservatives (eg http://www.ncbi.nlm.nih.gov/pubmed/22050823). Vinegar is a weak antifungal, eg http://www.ncbi.nlm.nih.gov/pubmed/19082396. I am not enamored of baking soda as an antifungal. Some studies show it to work better than vinegar, eg http://www.ncbi.nlm.nih.gov/pubmed/20027444, but it is harsher to our own cells.

    I’ve gone back to regular toothpaste and am experimenting with post-brushing rinses, eg a bit of Xylitol which is antifungal on teeth and gums afterward.

    Best, Paul

  42. Paul,
    Thanks so much for your very timely response! I will try your suggestions in slowly introducing probiotic foods, syrups and so on to my meat only diet. As I am not in a position financially right now to do stools tests, are there any natural broad spectrum antibiotics you find effective in situations like mine? Do you think a low carb diet will fix the pathogenic overgrowth by itself or are antibiotics necessary? Also, are probiotic supplements necessary or just the foods? I have had bad reactions to probiotic supplements in the past.
    I sincerely appreciate your help and wisdom!

    Hi Kate,

    Doctors who have experience with bowel diseases would be in a better position to suggest antibiotics. Different pathogens need different antibiotics. The ones I used in the past that helped me were (a) doxycycline (for cognitive symptoms, rosacea) and (b) amoxicillin with clavulanic acid (for UTI, rosacea), but my conditions were different from yours. I have no idea what would work best for you.

    I think antibiotics will help, in combination with that sometimes inducing diarrhea-like bowel emptying can reduce the pathogen load and help probiotic flora take root. Such bowel emptying is done before imaging procedures and fecal transplants. This works in the colon not the small intestine. Magnesium citrate could be a home laxative for this.

    Probiotic foods are more important, but I would give some consideration to probiotic supplements too. If you have a leaky gut any of these can cause problems.

    Best, Paul

  43. Thanks! So, the rice and tapioca syrups won’t feed the pathogens?

    Hi Kate,

    They might, but they’re the least likely to do so, so give them a try and find out.

    Best, Paul

  44. Hi Juan and Paul,

    For the last week I’ have been experimenting using Natural Factors “Certified Organic Oil of Oregano with Organic Extra virgin Olive Oil” to clean my teeth. Just one drop on my toothbrush – it’s quite a taste sensation! I definitely have a fungal problem and I’ve been thrilled that already the white fuzz on my tongue has lessened in thickness. I presume it’s doing my teeth some good too!

    Kind Regards

    Thanks Joan, sounds like a great product for Candida!

    Best, Paul

  45. Thank you Paul for the rapid response to our slaking (nixtamalization) questions… we’ll see how we feel over the next few weeks.

  46. Hi Paul,

    I just watched Forks Over Knives. What do you think of the China Study, etc?

    Hi Helena,

    We have a category for the China Study: http://perfecthealthdiet.com/?cat=43

    Best, Paul

  47. Hi Paul,

    I had a question regarding detox. I understand the concept is vague (comprehensive,etc) but I was hoping to narrow it down to the detox that someone can experience when losing weight. Whenever I start losing weight I get all kinds of symptoms, fatigue, trouble sleeping, trouble concentrating, headaches,etc. I know these may be common on restrictive diets; but mine isn’t restrictive, just normal PhD–enjoying spontaneous restriction of calories, nothing voluntary. I know that we may build up fat soluble toxins in our bodies, so it comes to reason that they get released back into our bodies when we lose weight. Like i said, I know this is super vague, but is there any chance you may have some knowledge on this? Any help is greatly appreciated. Thank you for your time!

    Hi Michael,

    I haven’t heard of that happening before.

    If, indeed, you have some kind of build-up of fat-soluble toxins, they would normally be excreted through the liver and bile, and then might re-circulate, re-entering the body along with bile and dietary fats.

    You can improve excretion of such toxins by using bile- or fat-binding supplements like activated charcoal, bentonite clay, or cholestyramine. If you use cholestyramine use a very low dose, you don’t want to lower serum cholesterol. Along with such detox aids, you should support liver detoxification pathways by taking glutathione-supporting antioxidants and support bile creation and conjugation with vitamin C, taurine, and dietary cholesterol.

    I think you need to try some self-experimentation here to get a handle on what’s going on. Also, you might check that your vitamin D levels are normal, not too high or too low.

    Best, Paul

  48. Thank you Paul for the response about the Carageenan. I just finished an email to the company whose product I bought that had carageenan and kindly explained and asked them to remove it. We’ll see, I figure if lots of us request it, maybe they’ll take it out. ?

    I wanted to ask about leaky gut… (sorry if the answer to this is already in your book, we’re still patiently waiting for it 🙂
    1) Are there ways to tell if you might have a leaky gut? Would I look for signs like diarrhea, inconsistent BM? Gas? Or could someone still have a leaky gut even if they don’t show those outward signs? How might someone make a good guess that they might have leaky gut?

    2) How long might it take for someone to recover from leaky gut once the toxins are removed? (I’ve been following PHD for about 3 months or so– eliminated wheat, corn, legumes, initially I included some tree nuts, but have eliminated those for now, no sugar except for fruit when my blood sugar drops, lots of Kerrygold butter, eggs, coconut oil, meat, only rice and potatoes, lots of spices in those yummy Indian dishes!)
    Would I just monitor daily BM to gauge my progress with regard to healing a leaky gut?

    Quick milk update…
    For the past three mornings, I’ve used only goat’s milk in my coffee (I was concerned that the cow’s milk protein might be affecting me possibly…) and all three mornings my BM has been consistently normal, not loose. I think this is kinda big because normal BMs have never been consistent for me. Just wanted to share (sorry, not the most fun topic) in case there might be others who might have a similar problem.
    Are there any milk experts out there who might be able to share any knowledge on this?

    Thank you all so much!

    Hi KH,

    When leaky gut is severe, the main symptom is that you develop many many food sensitivities, and will have a strong immune reaction after meals. Your gut may bloat, you will get tired/sleepy and your brain won’t work well for ~3 hours after a meal.

    When it’s mild, it is harder to tell but almost any gut disorder will produce a mild leaky gut. They have tests for leaky gut in which they feed you some compounds that normally don’t enter the body and see how many come out in urine. But the test isn’t commonly done.

    There’s no telling how long it may take to heal a leaky gut since it may be due to pathogens / gut dysbiosis rather than toxins. If symptoms continue after months on a good diet, focus more on eating fermented vegetables and yogurt and re-shaping gut flora.

    Your diet sounds great!

    It’s great that goat’s milk improves your symptoms. Some people are sensitive to cow casein. Sheep’s milk will probably be good for you also.

    Best, Paul

  49. Hello, Paul. I hope your 2012 has begun well.

    I do not mean to pester or rush you, but I’m curious as to whether you have any thoughts about the question I asked above (around 11/24/11). I have had the itching problem I described for decades, so any progress would be noteworthy and potentially of interest to fellow itchers.

    Thanks again for your helpful book and website.

    Hi MI,

    Sorry about that, I’m months behind on multiple projects, not just the comments thread. As I get time I’m gradually working my way back to older questions.

    For now, I can tell you that I don’t offhand know anything about itching. The only thing I’ve ever posted on it is this: http://perfecthealthdiet.com/?p=3483#3. You might want to Google Dr. Oaklander and see if she’s written anything helpful.

    Presumably itching is due to some neurological pathology, which might involve neurotoxicity or some infection of the nerves. I would try a ketogenic diet if you haven’t already, it often helps neurological issues.

    Best, Paul

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