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. Hi Paul,

    A friend of mine in her late forties went to a clinic a few days ago for some tests due to her not feeling well and after taking blood they discovered her triglycerides were very high. The family didn’t tell me what the number was but they said that the doctor said it was a miracle that she didn’t have a heart attack. (Is that response accurate? Could extremely high triglycerides cause a heart attack?) Anyway, the family is from Guatemala and they only speak a little English and I know they don’t have much knowledge on nutrition (not yet anyway) but I want to try to help them if I can. They told me the doctor prescribed something and she started taking the pills yesterday (I didnt ask yet but I was hoping they werent statins. Is that a possible protocol for high triglycerides?). I don’t know the reason for the high triglycerides but I suspect the obvious– due to their situation, it might be lack of nourishment in addition to extreme stress and depression (the one year anniversary of the murder of their son is coming up in a couple weeks and his 23rd birthday would have been a week ago). I want to send them some vitamins, but I think for now I have to start at the very bottom, just basics for them because they don’t really have any knowledge yet about nutrition I think. What would you suggest for her?

    The family is so nice and such good people, they are so humble and I want to help them. As an aside, the family was brought here at least once a year from Guatemala through a program at NIH in Maryland because their daughter (now 16 years old) had some form of leukemia (and thank God, her other brother was a perfect match for a bone marrow transplant which they did a few years ago). So, they’ve been so blessed by that and over the past 6 or 7 years they’ve come to know many of the kind doctors and staff at NIH, but I don’t think they are well-grounded in the nutrition side of things.

    And, I know I read something on this site about why statins are bad, but I can’t remember what it said (I’m reading way too many topics at once I think) or where I read it. I think they inhibit some necessary process or the production of… something….?? please help!

    (Sorry, I really do set out to write shorter posts, but as it turns out I’m just entirely too detail-oriented… sorry…)

    Thank you Paul and Shou-Ching! 🙂

  2. We just learned of a friend’s worsening medical problems and look to you to tell us what part of PHD might benefit her and if in fact PHD is a good idea for this condition.

    Our friend told us she has been diagnosed with Reflex Sympathetic Dystrophy RSD for short. She for a long time suffered from undiagnosed Clostridium Difficile (C-Diff). As a result of the untreated C-Diff (finally cured with faecal transplant) her body over produced antibodies to fight the C-Diff and now those antibodies are pooling in her ankle and knee as they are the weakened spots on her body due to sprains and surgeries (skier). As a result of the pooling antibodies the affected areas are suffering rapid degeneration.

    As you are aware RSD attacks the bone (whereas with arthritis it’s the joint) –– she claims “no one knows why this happens” –– and that “few if any” doctors have seen RSD in their practice. She has been told she has been left with “reactive arthritis” and that there is a 50% chance of eliminating that condition but there is a lingering chance she faces amputation of the limb.

    I am new to PHD and Shou-Ching’s and your work but it seems to me that PHD has a number of potential benefits to my friend’s condition aside from the general health benefits. We do not know what meds she is on but if necessary we can ask.

    If you can shed light on this matter it will be greatly appreciated.

    Thank you to you both.

  3. Hi Paul-
    When I donate blood I notice my dietary cholesterol is dependent upon my current fat intake.If I eat my 3 free range egg yolks per day,My heavy pastured cream in morning coffee,and coconut oil during the day,my reading hovers around 220.If I cut the eggs and cream a week before donating,the reading drops below 200.Is that of any significance?

    Hi john,

    Hard to say without more information, probably not very significant, but it might have some diagnostic value for a mild imperfection. I tend to think that 200-240 mg/dl is best so below 200 may be a bit low. Then it should be fairly stable regardless of diet so the fact that cream raises it may indicate something – a mild micronutrient or thyroid deficiency, perhaps. If your diet is a bit lipid deficient then the low cholesterol could be due to a lipid deficiency which the cream is fixing; but I doubt that. What is the cholesterol breakdown? Is HDL low? Is it LDL, HDL, or other (VLDL etc) which is changing when TC changes?

    Best, Paul

  4. Hi Paul,

    Firstly, just wanted to say that i appreciate all the hard work you put into your blog.

    My question is to do with strength/speed/bodybuilding athletes and macronutrient proportions.

    While a lot of your suggestions on macronutrients make sense to me, they for obvious reasons directed at a more general population.

    While I am no Olympic athlete or gargantuan bodybuilder, i train weights hard and heavy 4 times a week and try, i will have a higher muscle mass than your average reader and due to the intense exercise will most likely have better glucose processing. I feel to fuel my workouts i need more carbs than your suggested 20%, these come from safe starches and low fructose fruit but is closer to a third of calories.

    I also believe that due to the exercise i require higher protein then you suggest, again closer to a third of calories. The remaining third is from fat.

    What is your opinion of this sub-group of the population whose activity type and intensity is far different to the average person, can we be justified in our greater protein and carb intake?

    Hi Will,

    Yes, athletes absolutely do need more carbs and protein – mainly carbs, but extra protein is not amiss.

    For protein I wouldn’t go above 150 g / 600 calories per day. That should be sufficient for any athletic purpose. Raise carbs rather than protein above that.

    For carbs, start from a base of 30% of calories and adjust it a bit depending on the length and intensity of your workouts. The higher the intensity of exercise, the more the fraction of energy consumed as carbs; length of exercise affects total calories. An hour of running might use 1200 calories with a 50-50 split, so 600 carb calories. You can get estimates on the web. You want to eat near your usage.

    Best, Paul

  5. Hi Will,

    Just thought I’d give a heads up on some of what Paul has said on dietary requirements for bodybuilders and the like:

  6. Thank you Paul for your answer about cholesterol.The blood bank doesn’t break it down to HDL/LDL…But my body temperature has been a little low,in the 97’s,so maybe it is a mild thyroid deficiency…Why does the medical profession want to put people on statin drugs when their cholesterol is 200 or above?

  7. hI PAUL
    how do you implement phd with a daughter of 4 old years with gut dysbiosis..severe food allergies,diverticulous..and severe oxalate reactions?
    thank you
    cassiel getz

  8. Hi Paul,

    What can an extremely dairy-sensitive guy with yeast overgrowwth and virtually no healthy gut flora do to heal a leaky gut?

    A Doctor’s Data stool test has ruled out parasites and infections.


    Hi Joe,

    Did the Doctor’s Data test confirm the yeast and the lack of bacteria?

    If so, the obvious thing would be antifungal medications and probiotics and fermented vegetables (http://perfecthealthdiet.com/?p=5165). Also, for gut healing, extra vitamin C, MSM, bone broth soups, B vitamins (incl B6 and B12) and sufficient carbs.

    Best, Paul

  9. Hi Paul,

    Thanks for being so generous to answer questions like this. It is much appreciated. I wasn’t able to go through all of the comments so I hope this isn’t a repeat. My symptoms are: mild to medium rosacea, yeast, teeth grinding (day & night), weight loss, muscle wasting, sugar cravings, hypoglycemia, mild melasma, canker sores on tongue, chronic swollen gums, occasional bad breath, mood swings (depression, anger & anxiety), low energy (unable to quit coffee), mild eczema on hands (comes & goes), muscle aches. Before I had kids four years ago (I have two) I was very healthy and strong. I’ve been health-conscious since my early twenties. I’m now 35. I’m transitioning to your diet now. I know I also have the yeast to deal with, but am wondering if my symptoms point to other pathogens as well. I would love any insight you might have.
    All the best,

  10. Hi Paul,

    Your book is amazing, the two of you have made such a contribution. I have a few questions, I got Grave’s disease 15 years ago. My thyroid was radiated and I got the whole bulging eye thing and had massive reconstruction on my eyes and sinuses. First question, does someone with this situation still need iodine supplementation? I am not sure if my entire thyroid was completely destroyed or not?

    Next, I had a C-section for my daughter and I am having so many problems. First I was told I have Irritable Bowel. But nothing helps, not fiber, not the Primal diet, nothing. I am beginning your regimen today. I went on got allergy tested and nothing showed up but they told me I don’t have the antibodies to fight streptococcus, so they gave me a shot and sent me home. My sinus infections seemed to have subsided from it. I lived in NYC during 9/11, so my doctor put me on inhalers because I am only using 60% of my lung capacity, assuming the damage was done then by chemical and I have chemical sensitivity. I DON”T want to be on steroids for the rest of my life!!! Any ideas of natural solutions to this kind of problem?

    Lastly, I don’t suffer from depression, I have anxiety. But in my family there is extreme depression. I talk to everyone about diet and exercise, but it’s very difficult to make people understand. On my mother’s side of the family I had 8 cousins, I have lost 2 cousins to suicide, another 3 have tried, my sister attempted it last year, both of mom’s sisters and now my niece is cutting and threatening. I am desperate to help my family, but everyone says it genetic. I am even more fearful that my daughter who is 2 years old will inherit this “bad gene”. I don’t have these tendencies but I also take my diet very seriously as well taking yoga. I realize you mentioned bipolar disorder, but has any of your research shown that wheat can cause these extreme problems. My sister said I was trying to “simplify” things and diet has nothing to do with the chemical problems in our family. Am I way off here?

    Thank you so much and I appreciate any answers and time!

  11. Paul, thanks for taking the time to answer so many questions.

    I have been suffering from the following symptoms for 5 or more years and would greatly appreciate your advice:

    1. Chronic Sinus congestion/pressure (not sinus infection, just dry stuffiness no matter the season etc.)
    2. Post-nasal drip (have yet to find any patterns or triggers)
    3. Chronic fatigue and brain fog
    4. Bruxism
    5. Sleep Apnea (it may be slightly different from sleep apnea, I hold my breath after I inhale rather than after exhaling)
    6. Cold feet and hands
    7. Restless leg syndrome
    8. Depression(not anxiety) Just a feeling of apathy probably due to lack of energy and poor quality of sleep.

    Again, any advice would be much appreciated. I have lived this way for too long and I can’t imagine suffering another five years in this condition.

  12. Paul,

    Oops, I was going to add these…I read the article on depression and telomeres. Do you believe that your diet protects your existing telomeres or that it can actually lengthen them? It would be interesting to know.

    And as far as beef liver, does eating organic matter?

    Thanks again,

    Hi Amy,

    I would expect that a healthy diet would improve telomere status, but I haven’t looked into the research much.

    I think eating grass-fed or organic probably matters more for the liver than for any other part of the cow. Since it’s the detoxification organ, and one of the first organs to go bad in an unhealthy cow, it will taste better and nourish you better if it’s from a grass-fed animal. Muscle meats, it’s less important.

    Best, Paul

  13. Hi Paul,

    Your recent post about being unhealthy in our own ways got me to question your dietary recommendations. If we come to “hack” our dietary regimen, usually the case is we’re unhealthy to begin with. Meanwhile your recommendations are based on healthy people, be it from an evolutionary standpoint, a post digestion vista, or be it the breast milk paradigm. I’m referring specifically to your carbohydrate recommendations, I notice that you never got as far as promoting taking in above 200g carbohydrate. My dissonance is based on reading some of Ray Peat’s work. I notice he bases his conclusions on the many possible, and likely (in this day and age), metabolic disruptions that can be present within any said individual. I know you’ve discussed bacterial infections and sympathized with a high fat diet, but is there any chance you can discuss the merits of using a high carbohydrate intake to remedy some kind of metabolic entropy (to put it lightly =) )–this is a personal question (though it may not sound like it) as I’ve attempted eating akin to the phd outlines, varying only very slightly, without many results to speak of; it was only after occasional carb binges and such that I felt better and subsequently brought into consideration ray peat’s recommendations. Sorry to make this so long, but any help is greatly appreciated!

    Hi Stan,

    I think some people may benefit from eating over 200g carbohydrate, but at this moment I don’t know who beyond athletes and hepatitis victims.

    Hopefully we can learn from the experiences of people like yourself. If you develop any insight into why you need more carbs, I’d love to hear your thoughts.

    Best, Paul

  14. paul & stan & others, what defines “athlete” in the context of modern man? does having a job in a movement based position such as restaurant worker make one an athlete if they are lean-ish and do not eat bad foods? what if they bike to work everyday? are they athlete-ish?
    perhaps they may be moderately active but also chronically ill in some regard and thus the “extra” carbs are necessary to decrease stress?

    i have been playing around with the peat suggestions and i do better mood & energy-wise with more (150+g)simple carbs from fruit, dextrose, sugar, d-ribose; less fat; and very high-protein around 2-2.5g per kg of bodyweight. as mentioned earlier in this q&a i found starches were hurting me, then switched to brown rice syrup, and now to even faster assimilating sugars. i am by no means healed of my leaky gut & IBS but far better than i have been in years, consistently stable and slowly improving in quality of life. it is very very interesting.

    Hi Darius,

    That’s great news, I’m glad you’ve found a path that is healing. Gut ailments are hard and if the problems are in the colon, then simple sugars will often be the best tolerated carbs.

    Best, Paul

  15. Hi Paul,
    Suspecting that I have a systemic fungal infection, I have been on an herbal antifungal and Interfase for two months, but a month ago I had a Metametrix stool profile that showed pinworms and low levels of good bacteria but no pathogens or yeast/fungi. Is it possible to have a systemic yeast/fungal infection without it showing up on the stool test?
    My 4yo has had lifelong digestive issues and dairy sensitivity managed with diet. Her stool profile showed literally off the charts high levels of all obligate anaerobes and aerobes plus enterobacter and cryptosporidium sp. and H. pylori. How would you treat this if it were your child?

    Hi jtl,

    Fungi tend to do best on epithelial and skin surfaces, so if you don’t have a fungal infection in the gut and you don’t have one on the skin or tongue, then it’s unlikely you have one systemically.

    So I would try to treat the pinworms and replenish good bacteria with probiotics, yogurt, and fermented vegetables (http://perfecthealthdiet.com/?p=5165).

    Re your daughter, I would consult a doctor. Personally I think a good strategy would be to start with an antimicrobial for the cryptosporidium (a protozoan) and antibotics to beat down the bad bacteria, plus probiotics and fermented vegetables to replenish good bacteria, adding yogurt once dairy is tolerated. I would start the antimicrobials first before taking a lot of fermented foods, they might stir up the pathogens. If that doesn’t work then a fecal transplant would be the backup approach. However, consult a doctor and see what they say.

    Best, Paul

  16. hI PAUL
    how do you implement phd with a daughter of 4 old years with gut dysbiosis..severe food allergies,diverticulous..and severe oxalate reactions?
    thank you
    cassiel getz

    Hi Cassiel,

    Start by getting her a stool test, eg http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology, and treat any pathogens found. She certainly has some.

    In the meantime, implement the best version of PHD diet and supplements as you can while avoiding her allergies and sensitivities. Simple sugars with minimal fiber are usually best, try rice syrup as a source of carbs. Try to make beef bone broth, include some organ meats in her diet, seaweed and shellfish, salmon and other fish. Butter, coconut oil. Yogurt and milk are great if she tolerates them, goat milk may be easier than cow’s milk.

    After you’ve begun treating pathogens, start introducing fermented vegetables and foods like yogurt, plus probiotics.

    It’s tough but do the best you can, and as you treat pathogens and improve the flora then she should steadily improve.

    Best, Paul

  17. Hi Paul,

    Sometimes when I start a new supplement, for a night or two I get very vivid, often disturbing, dreams. This happened with my multivitamin and iodine (and others), but not, for example, magnesium. Most recently this happened with melatonin, which created some nutty dreams and super shallow sleep the first two nights. I’m only on night 3 and wondering if my reaction means I shouldn’t take melatonin. Maybe this is a period of adjustment?

    Does this reaction to supplements carry any diagnostic value that you know of?

    Many thanks for your time.

  18. Hello again Paul
    I know you are very busy answering questions. If you do get a chance to answer my food questions of January 14th, could you please also comment on acceptable flours (spelt, coconut, rice, buckwheat etc?) I’m also curious about your take on wheat grass – is it toxic as well? And legumes – are there any (garbanzo,dal etc.) that are more acceptable than others? I do have your book, but am having trouble with a few of the specifics pertaining to ingredients.
    Thank you again.

  19. I’m new to the site and don’t see how to submit a question, so I’m entering it here.
    Is pasteurized process cheese a healthy source of fat?

    Hi Dusty,

    Basically, yes, but why get a processed form of dairy fat when you can get grassfed butter or sour cream instead?

    Best, Paul

  20. Hi Paul!

    I know that you don’t recommend fish oil supplements for good reasons. But what do you think about the quell fish oil named “Supercritical CO2 Triglyceride”?


    It is any better than a standard fish oil product obtained by molecular distillation?

    Hi Andrei,

    It sounds great. Unfortunately, I don’t know enough chemistry to compare the two methods.

    Best, Paul

  21. remove me from the e-mail question and answer list

    Hi Felicia,

    I don’t see your email address on the subscription list. You can remove yourself from the list: Go to the very bottom of the page and look for the “manage your subscriptions” link.

    Best, Paul

  22. Paul,

    Got the blood panel back that I mentioned above. Just thought I would share the numbers and ask for some quick thoughts.

    TSH 1.18 (late 2010 it was 1.12)
    Vit D-40 (late 2010 it was 42)
    Cholesterol-216 mg/dL

    My doc said she thought my cholesterol was a bit high, but because I lead a healthy life she is not terribly concerned.

    I am thinking my LDL is a bit high and my HDL could stand to increase. I wonder if the increase in TSH and the high LDL point to a mineral deficiency/hypothyroidism.
    I read through your past posts on HDL/LDL, but failed to find anything on your idea of optimal levels of these markers?



    Hi Lindsay,

    I think your numbers are just about perfect. The mortality minimum for TC is 200 to 240 mg/dl, you’re right there. The mortality minimum for HDL is 70 to 80 mg/dl, you’re there. (That’s not to say that raising HDL further would not be good for you – it probably would be – but some unhealthy people develop very high HDL.) There is a broad range of healthy levels of LDL, yours is fine.

    There would be nothing wrong with raising HDL or lowering LDL a bit, but I think you should be very happy with these numbers.

    Best, Paul

  23. Hey Paul,
    Thanks..Just to clarify for my little girl…
    until we find out the pathogens, then her diet should consist of
    no fructose(meaning all fruits)
    no glucose(all rice,sweet potatoes)

    brown rice syrup as a sweetener or carb sorce
    (no carrots, or suash?
    just boiled meats, broths, and low oxalate veggies, and fats such as tallow,lard and coconut oil?
    because of leaky gut, and everything bloating her…she is in no way ready yet for raw dairy..
    Also, without “bowel rest” how to colitis,diverticulitous patients get rid of the hard distended belly?

    thanks Paul,

    Hi Cassiel,

    If she tolerates white rice fine, then that is an excellent food. You have to experiment to find the carb sources that work best for her. Some people can tolerate sugars but not starches; others starches but not sugars. Sometimes it helps to have starches pre-digested, ie rice syrup rather than rice. You have to experiment and see what works for her.

    Nourishing vegetables like carrots and squash are desirable to include in the diet, because of their nutritional value, but again it is possible that she may be sensitive to some component in them. So see how she feels.

    Boiled meats, broths, veggies, and fats is not a sufficient diet. You need to find carb sources for her, even if it’s as simple as rice syrup. Try items in our food plate to see if she tolerates them; if she doesn’t then go on to easily digestible sugars like rice syrup or tapioca syrup.

    Are you sure she won’t tolerate dairy? Have you tried goat or sheep milk?

    Best, Paul

  24. Hi Paul,

    My father has recently been diagnosed with ALS. Although the symptoms started showing in September 2010, but its only now that we found out about the disease.
    I have read articles in PHD about the ketogenic diet being helpful in neurological disorders.

    Currently, he has started taking about 6tsp coconut oil everyday apart from the usual diet. Could you help me in forming a suitable diet for my father which is ketogenic and has sufficient carbs+protein. Also what supplements would be helpful?


  25. Paul, I have a question about vitamin K. In your book you recommend 1 mg supplement per day. My supplement, which I bought through the recommendation on your website, is 90 mcg per tablet. Do you really recommend taking 10 or 11 of these tablets every day? Or have I misunderstood something? Thank you. Andrea

    Hi Andrea,

    No. A 90 mcg tablet will provide 80-90% of the benefit of a 1 mg tablet. I think that’s the best way to start vitamin K2.

    If you look on our recommended supplements page you’ll see we like a Life Extension formulation that has a mix of K1, MK-4, and MK-7. That’s about 1 mg K2. I think getting all the different forms is probably advantageous.

    However, you don’t need to take that every day.

    Best, Paul

  26. Paul, thank you for your quick response. A question about coconut oil. It makes me feel sick! I tried drinking 1T like a medicine, and it woke me up with the nausea. I tried using a smaller amount to sautee some sweet potatoes, and I still felt queasy for several hours. Now I don’t even want to look at the stuff! Suggestions?

  27. paul, my last stool test indicated abundant mixed gram negative flora, but rare mixed gram positive flora. how do i increase my gram positive flora?
    i am taking 5grams of klaire prebiotic FOS and 1 serving of klaire therbiotic complete probiotic in the morning on an empty stomach hours between meals. (i also take some Sach. boulardii everyday.) is this enough? am i in the right ballpark?

  28. Paul, do you see any common threads or a single root cause that would explain the following symptoms?

    1. Chronic Sinus congestion/pressure (not sinus infection, just dry stuffiness no matter the season etc.)
    2. Post-nasal drip (clear drainage) (have yet to find any patterns or triggers such as dairy or environmental)
    3. Chronic fatigue and dark circles under eyes/puffy eyes
    4. Bruxism
    5. Sleep Apnea (it may be slightly different from sleep apnea, I hold my breath after I inhale rather than after exhaling)
    6. Cold feet and hands
    7. Restless leg syndrome
    8. Depression(not anxiety) Just a feeling of apathy probably due to lack of energy and poor quality of sleep.

  29. geek/ocd question alert:

    provided that the suggested foods would not cause g.i. distress in the individual, what would be the foods to provide the necessary micro-nutrients (vitamins & minerals)? cost is not an issue, but i want to find the minimum effective dose/type for the maximum benefit.

  30. Sounds Good Paul
    I orded the metametrix test test today.
    One other issue we are facing with her is gallstones..due to liver overload and cramped bilary ducts.
    She has avery slight slight yellow hue to her. I am sure of this because her rectal prolapse started happing
    very young2 1/2, and her gut dysbiosis wasnt being treated until age 3 1/2.
    And her diet high in oaxalates(which lead to absorbtion of calcium which calcifies and turns to stones)
    Yesterday I did a small half of day fast..fresh pressed apple juice and broth, then before bed,olive oil and lemon juice to try and flush out ministones. she had some yellowis diarhea this morning(i assume was stagnant bile) but no stones.
    Alot of herbalists and nutritionist say that you have to do a parasite cleanse first to rid the body and then the stones will come easier.
    Any thoughts?
    I got the rice syrup, and will experiemnt with the starches and see how it goes.
    you are so much nicer than Kresser!

  31. Hi Paul,

    Do you think that with proper diet, many people can wean themselves from thyroid medication? I’ve been taking desiccated thyroid for over a year now. My TSH was only 3.5, but my free T4 and free T3 were at the bottom of the range. There were no detected thyroid antibodies. I felt quite a bit of relief when I started on medication, although I can’t say I feel as fantastic as I did those first few months when I felt positively transformed. But I hate the idea of being dependent on a medication. I get scared that I will at some point not have access to it, and it will be a disaster. Also, I’ve read women have a much higher rate of breast cancer when they’ve been on thyroid medication for some time. I’m also itchy a lot since being on thyroid.

    Do you think a combination of proper nutrition and addressing infections would be enough to reverse hypothyroidism in most cases?


  32. Hi Paul,

    I just wanted to follow up my previous question above to let you know I realize you can’t diagnose over the Internet, etc. I am just looking for help moving forward with whatever chronic infection I’m dealing with. I’m planning on getting a stool test, but I’m uncertain about other testing I should do based on my other symptoms. I do know from neurotransmitter testing that I am low in Serotonin & cortisol. I know (like I said above that yeast is a problem for me) yet Diflucan did not work for me. It actually seemed to make my yeast symptoms worse at the time. Although when I took it I was not on your diet. I was trying to eliminate yeast in my breasts/thrush in my son.

    I have another question for you too: Can you comment on the use of Soil Based Organisms to treat dysbiosis & infection? I’ve been hearing about them and wondering about using them to combat Candida or other pathogens.

    Best to you,

  33. Hi Paul and other PHD people,

    I started the diet two weeks ago. Pretty much straight away I noticed that I was feeling fatigued when I woke in the morning. Today I was feeling super tired and woke up with a gut ache which tuned into diahrrea. I had a few bouts then recurring waves of nausea every twenty minutes or so. It’s late afternoon and I’m still feeling yucky. My ears have also spontaneously become blocked – a very weird range of symptoms!

    Previously I was on a high sugar, high grains diet and ate very little saturated fat. Despite all the fat I’ve been eating, I have lost weight which I still can’t get over!

    I was wondering if anybody else has experienced these side effects and what the explanation might be. Is “die off” a real thing? Sorry if this has come up before – I couldn’t find a relevant post.

    I have to point out that I haven’t started supplementing yet.

    Thanks for your great book and website,

  34. Hi Paul,

    I am beginning the process of transitioning to your diet. It’s hard because when I eat in the morning I feel nauseous. I typically don’t eat anything until almost 11am. Is it okay, can that be considered intermittent fasting if I eat from 11am until 6pm?

    And also I want to confirm the breakdown of the carb/fat/protein intake. Before I start things I like to double check so I don’t do more harm than good! I am 5’8 and 137 lbs. Moderately active. So if I eat 1800 calories that would be 45g carbs/day 146g fat/day and 67g of protein?

    Thank you.

  35. Good morning Paul,

    Could you (or anyone else reading this) recommend some good resources for explaining all the different internal mechanisms of typical type 1 diabetics?

    I’m just having trouble, for lack of understanding on my part, knowing which things of the diet to tweak for myself and why. I’m trying to read all this complex information through “diabetic lenses” so that I properly apply the diet for my body’s needs/ abilities. But I’m having trouble, aside from just guessing and trying something out, since I don’t really know the complex things happening/ not happening in a diabetic’s body (aside from the basics). For example–liver glycogen stores, muscle glycogen stores, what if any pancreatic functions work, etc.

    Many things I do come across are very superficial and don’t provide complex explanations, and most places I look of course recommend lowering cholesterol! I’m trying to raise it!

    I’m so thankful to you because you do give a lot of hope on this site. Whether it’s appropriate and warranted or not, I am determined to help my body heal– I’m tired of just accepting this disease. If I help my body have just the right internal environment and nutrition, why wouldn’t it have a chance to heal?

    To all– keep hope alive! 🙂

    Many many thanks,

  36. Hi Paul,

    I was wondering if you clarify a few aspects attributed to your promotion of safe starches. Coming from a primal/paleo diet (consuming roughly 50g of vegetable based carbs per day) for nearly a year now, I have found your claims to be incredibly intriguing and well argued, yet I am still left with some unanswered questions. First, if I do not display any symptoms of glucose deficiency (ie. lowered thyroid, or elevated triglycerides), is there any point to consume a safe starch? Additionally, following on the assumption that I allow myself 1 “cheat day” a week (I consume A LOT of grain-based carbs, sugars, etc.) would that not replenish my stores of glucose (I do recognize this is not the most healthy way, but I am willing to accept that)? If so, for how long? If I eat very strictly for the week (again, at most 50g of vegetable based carbs a day, if not less with IF), how long would it take to again be deplete of glucose stores and needing a safe starch? Finally, if in fact glucose deficient, how much safe starches are needed? Dr. Mercola cites that only 200 calories of safe starches are needed per day to replenish glucose stores? Is this accurate? If one is still trying to lose weight, do you maintain these 200 calories and simply reduce fat calories as he allude to in your book? What of the resulting insulin spike? Thank you so much for all of your help!

  37. Paul,

    Thank you so much for your book and website. I was wondering what you thought about parboiled rice. I hear it has much of the nutrients of brown rice with out the bran.

    Thank you,


  38. actually Kresser’s cool, i guess you are just more thorough! 😉

  39. Hi Paul,
    Can you outline your ideas for the treatment of yeast overgrowth/Candida? I have followed a couple of different diets that were low carb. For about eight months I did a low carb adaptation of the GAPS diet (no winter squash, carrots, nuts except almonds, limited fruits-just green apples, berries and white grapefruit). I felt like it helped with my weight, gas/flatulence, and the yeast. I also had h.plyroi and a recent test (breathe and stool) in November said that I no longer had it. After hearing you at WAPF conference, I realized that my toe fungus might have been related to the low carb diet. Also, I had terrible dry eyes which I just learned is probably related. Since August, I went off the diet and have been eating gluten free grains and legumes. This has not been working so well and my gas/flatulence has returned and it appears that the yeast has become a problem again (Also Dr. Natasha Campbell-McBride says the excessive gas is due to yeast overgrowth). So what would you advise? I am a little weary because almost all candida protocols warn against grains. Plus, in the past my hemoglobin A1C has been a little high.

    With gratitude,

  40. Just to clarify I am a little weary of starches such a white rice, potatoes, and sweet potatoes.

  41. Hi Marisa
    Die off is real, especially if you are transitioning from a SAD diet. Take it easy and be gentle with yourself. You might want to eat at the upper level of carbs and then slowly wean yourself down. You might also be having problem digesting fat which can happen on a low fat diet. To help with that have about a teaspoon or so of raw apple cider vinegar (Bragg’s or Eden are the best brands) about 10 minutes before you eat.

    Hope that helps!


  42. Thanks Angela, much appreciated. I’ll give it a go. I’m starting to feel a lot better today in any case.

  43. Hi Paul,

    Would you say that soaking and dehydrating nuts is necessary as recommend by C.Kresser? He recommends staying away from nut butters too because they haven’t been soaked, etc. Also, the WPF says that sourdough breads are OK? Any insights into that? Many thanks!

  44. Hi, Paul –
    I’m just finishing reading Perfect Health Diet and starting to transition onto the diet. I just love the book. I am curious about why turkey is never mentioned. Does it contain toxins? Does eating turkey have some detrimental effect?
    – Debra

    Hi Debra,

    Turkey is fine, it’s similar to chicken. All birds are fine to eat.

    Best, Paul

  45. PS: A little background on the turkey question. I have food allergies, severe enough that my throat has closed a couple of times. One theory that I’m working with to try to minimize allergic reactions is to never eat any one food more than 3 times a week, as we are most likely to become allergic to foods we eat the most of. So including turkey in my diet has helped me to not overdo it with other protein foods. So I’m wondering whether you advise against eating it for any reason.

  46. Soil-Based Organisms

    Hello Paul

    I notice that someone, Nicole, has posted a question about soil-based organisms and I wonder whether you have any information about their safety. A while ago I Googled “Dangers of Soil-Based Organisms” and found a warning about them from Jini Patel Thompson, who runs a website called listen2yourgut:


    The gist of it is that people often feel better for a while when taking SBos because they are so efficient at displacing pathogenic bacteria but that they may produce spores and take up residence opportunistically in the gut and therefore cause problems of their own, being very hard to eradicate. The article mentions at the end that Garden of Life have quietly removed SBOs from Primal Defense.

    I would be interested to know whether you have a view on this.

    Thank you again.

  47. Hello Paul,

    I’ve been posting in the High LDL thread but no one seems to be responding there. Anyway, this is a long story but I’ll try to keep it as short as I can:

    I had high LDL and TC last summer while following a predominantly low carb diet with carb refeeds on weekends. LDL was ~250 and TC 376. With your help, I made certain changes to my diet and added a few supplements which got my TC and LDL down to acceptable levels. This is how my lipid panel looked like on 15-Oct-2011:

    TC: 280
    HDL: 81
    TG: 60
    LDL: 155 (Iranian)

    At this time, I was eating plenty of fat (beef, coconut oil, nuts, some dairy) and carbs were on the lower end of your recommendations, around 100g/day from starch and veggies. I was not carb cycling.

    Happy with my cholesterol, I started the Leangains protocol back in Nov 2011 which calls for IF (16 hour fasts daily) and carb/calorie cycling. I stuck to a plan of 1.2 x maintenance calories on training days and 0.8 x maintenance calories on rest days. I workout 3 times a week, so I was still in a slight weekly deficit. I increased my carb intake to about 200-250g on WO days but still ate plenty of fat (150g+). On rest days, I limited carbs to about 60g per day and ate mostly protein and fat. Keep in mind I was eating mainly potatoes, bananas and milk for the carbs.

    After 8 weeks of Leangains, I got my lipids checked again and got these horrendous results (7th Jan 2012):

    TC: 380
    HDL: 84
    TG: 68
    LDL: 241 (Iranian)

    I couldn’t make sense of this but I decided to do the following:

    1) Add back almonds/cashews for some MUFA and PUFA. I’d stopped eating them since starting Leangains. At the same time, reduce dairy, coconut oil and egg consumption by a bit.

    2) Still continued using CO for cooking beef, but stopped having omelettes. Switched to boiled eggs instead.

    3) To balance omega-6 from nuts, I would eat 600-1800mg of EPA+DHA fish oil in addition to my daily can of sardines.

    4) Despite my aversion to very high carbs, I decided to make my WO days more compliant with the Leangains recommendation of low fat-high carb for a better anabolic effect. Decreased fat to 70-100g and increased carbs to 400-450g for WO days.

    5) Rest days stayed pretty much the same, with carbs around 50g.

    After 3 weeks of making these changes, I just got back these numbers (28th Jan 2012):

    TC: 396
    HDL: 74
    TG: 89
    LDL: 274 (Iranian)

    As you can see, everything got worse! It seems adding in nuts in place of coconut oil and some of the dairy and increasing WO day carbs/decreasing fat had a negative effect.

    Is there something wrong with the way my body handles carbs which has resulted in such a huge jump in cholesterol? Keep in mind I just eat more of the same healthy foods: potatoes, bananas and milk on WO days.

    I have continued eating a good multivitamin and supplementing with Vitamin D & C. The only thing I stopped taking was Iodine but that was back when my lipids were normal. Plus, I get 150mcg Iodine from the multi anyway.

    I have never heard of someone’s lipid profile worsening so dramatically from eating differing carb/fat ratios. I am wondering if carb cycling is something I can continue doing. My results in the gym have been amazing and I feel fine for the most part.

    A few things which seem odd: I feel warm, sometimes overly warm despite it being winter here and sub-10 degrees celsius temperatures. Plus, I have terrible gas issues after eating all those carbs, something quite embarrassing actually. Finally, I need to go pee in the middle of the night everyday and then have trouble going back to sleep. However, this could be due to my 3-5 mugs of black coffee daily.

    My main focus is what I need to do to get my lipids back from ‘crazy’ to ‘normal’. I would really appreciate if you could chime in with something here.




    Hi Jarri,

    I’ll be posting on this soon, but here’s the gist of it: High LDL on low-carb Paleo is due to a combination of being too low-carb (which reduces thyroid hormone and LDL receptor activity) and oxidative stress (usually due to a lack of antioxidant minerals: zinc, copper, selenium), possibly compounded by hypothyroidism (usually due to infection or to selenium or iodine deficiencies).

    So the solution is to eat more carbs and to supplement micronutrients, especially zinc, copper, selenium, iodine, magnesium, vitamin C, maybe a little vitamin E as mixed tocopherols and tocotrienols. Also, address any hypothyroidism.

    Best, Paul

  48. Paul,

    That’s the conundrum. I actually INCREASED carbs dramatically on WO days as per Leangains and things have gotten much worse. There was a time when I was eating in the region of 100g carbs per day and the lipids were good. I’m supplementing the same as I was back then, the only change is carb and calorie cycling according to the leangains method.

    I feared that maybe I was eating too much fat alongwith the high carbs on WO days, so I increased carbs even more at the expense of fat, and things got even worse.

    I shared my thyroid panel with you in Oct 2011 when the lipids had normalized and you said it was nothing to be alarmed about. Since then, I’ve been eating WAY more carbs and I now feel very warm at times, as I mentioned in the last post. Hypothyroidism doesn’t fit, I don’t think.


    Hi Jarri,

    First, I would still eat 100g carb on non-workout days, just eat more on the workout days.

    High temperature may be due to an excess of protein and fat because a deficiency of carbs or another nutrient is making you hungry. I got that high temperature when I had scurvy and a too low-carb diet.

    You’re right, it doesn’t sound like a thyroid issue. I would try eating a minimum of 100g carbs every day and supplementing minerals.

    Best, Paul

  49. Ok,
    so where is there a gI who would do a FECAL TRANSPLANT on a child.
    No one in our family has healthy guts, or i would do it myself!!
    I really feel its the best way and shortest!! the prolapse, diverticulitious,erything else going wrong in her little body all a result of gut dysbiosis!!
    I feel diet will just take waaayy too long!!


  50. Julie Lewandowski

    Do you have any information on salicylate and/or phenol intolerance? I have some symptoms of reacting to high salicylate foods and some chemical sensitivity. There appears to be a link between reduced PST enzymes and this type of intolerance. Is there any way to increase tolerance to the high phytonutrient foods that are also high in salicylates rather than only by eliminating most of them from the diet?

Leave a Comment

NOTE - You can use these HTML tags and attributes:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

This site uses Akismet to reduce spam. Learn how your comment data is processed.