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. A few questions: (Lots of processing here, so I enclosed my questions in **.
    –I have tried the morning fasting with only coffee and organic cream. Worked okay as long as I sipped the coffee all morning. The plan is difficult when my morning of teenagers gets crazy and I’m not able to eat until 1 or 2 in the afternoon. By the time I have dinner, it’s nearly bedtime and my stomach is uncomfortably full. Trying to fit in my smoothie and my eggs before bed, meant I was eating more than I felt I needed or wanted. But that blueberry, goji berry, chia seed, raspberry and coconut oil smoothie was my day starter, followed by my eggs. With the morning fast I have to forgo my evening veg juice completely. **I’ve packed on about 7 – 8 pounds since adding the cream and butter on my potatoes and eggs. Is it the butter? the cream?** I eat no bread.

    –**How can cream be included in a fast when it does provide some protein?**

    –I always felt my evening juice was my guarantee that I was getting the raw veggies I needed. Now, I don’t know if I “need” them at all. But my body seemed to like them. Recipe was one apple, 3 stalks of celery, several leaves of lacinato kale, and a wedge of cabbage. I checked a food toxins website and it seems ALL these have unfriendly toxins. The celery’s toxin does not cook or peel out. It supposedly makes people more sun sensitive. Well, celery juice seems to help me sleep. When I am on celery juice regularly, I don’t awaken at that dreaded 3:00 AM.

    –**Are fresh fruit and veggies so toxic that we should avoid them completely? If so, I’m going to need a 12-step program to help me kick this habit. No kidding. After decades of hearing about the importance of enzymes in raw produce I am now tormented with just wanting to stay healthy and not knowing what to do. I have been wheat-free for 17 years and grain free for several years. Don’t do legumes much at all (couple times a year — hispanic family). Off all veg oils for about a year, but off high omega 6 for much longer. Don’t own sugar — stuck with minimal sucanat, but now do only rice syrup. Never bake.

    **So I think I’m eliminating the toxins, just need to know how much damage I may be doing with my raw fruit and veggies.**

    Back to the fasting — I am thinking I need to be an evening fasting person, as I would rather go to bed with an empty stomach than a full one. My day starts at 4:40. Sucking down the cream laden coffee works, but it will gradually reduce me to one meal a day, and that would have to be a large meal to take in the nutrients I think I would need.

    Sorry for the rambling. Tried to order my thoughts but then I just ended up delaying my post and havinp having more questions. The websites discussing naturally occurring food toxins is very depressing. I thought berries and dark greens were our best friends. Here I go again. I am sorry. Anyone for a meetup in the Seattle-Snohomish area?

  2. Are well done meats safe to eat all of the time?I’ve been reading that raw is best,but that isn’t palatable for me.I’m trying to slow cook(crock pot) most of my dinners.I’m trying to only have eggs and bacon cooked in a cast iron pan.

  3. Paul,

    Interesting point you bring up there. I never thought I would be eating too few carbs because I was easily putting away 400-450g on my WO days, mainly from potatoes, bananas and milk. However, I was eating quite low carb, around 50g including veggies, on my rest days. Considering the fact that every week has only 3 WO days and 4 rest days, what you say does make sense.

    I’m upping the rest day carbs to over 100g and leaving everything else as is for the time being. If this doesn’t work, I’ll know for sure that something else is causing the rise in LDL/TC.

    Regarding micronutrients, I am getting most of them from my daily multi. It provides at least 100% of the RDI for all major vitamins/minerals except Calcium and Magnesium.

    What’s a good time to get retested now after making this change? My last test, where TC was 396, was done on 28th Jan.


  4. Hi,

    A late reply on posts of January 13 regarding toothpastes and mouthwashes to improve oral health. An Indian folk remedy is oil pulling.


    For me it seems to work, but it can also be the PHD that improved the color of my tongue. Unfortunately the 20 to 30 minute squishing process is about as tedious as this demo video!



  5. Dear Paul,
    I would like to ask your opinion about my ‘history.’ I’m Mark from Hungary and in my teens I was diagnosed (through urine and then blood test) that I have a benign condition called Gilbert’s disease, which practically means that there is a heightened level of bilirubin in my blood that may cause fatigue and occasional jaundice. I was advised not to consume alcohol, paracetamol or any kind of toxic substance. I’m 28 now and I have never been drunk (barely ever drank more than a few sips at a time) or intoxicated. Also, I avoided greasy food and ate less and less meat over the years. Actually, I did not feel there to be any problem with my health until I went to university. In general, I ate and slept rather poorly plus I went through an extended period of heavy stress (love-sickness) after which I started to develop migraines, a sensitive throat and psoriasis as well. Since then I had headaches almost every week (and a collateral flare-up of the psoriasis as well). Experientially: there was a pressure weighing down on my mind/head/brain almost all the time, and this worsened over the (7-8) years till I came across the Gaps diet at the end of 2011. I became much more conscious of my body and started to realize a few things about myself: like, for example, the fact that I have always been constipated for as long as I remember (going to stool 3-4 days, approximately) and I also realized that my skinniness (now, I am 52 kg and 175 cm tall) is not normal at all, that it may signify malabsorption of nutrients. As soon as I went entirely gluten- and almost totally sugar-free my headaches went away (more or less) and my mind cleared a fair bit. I started taking probiotic pills as well a month ago. Recently, I have come across your blog and felt the urge to contact you. At present, I feel better but I caught cold 3 times recently and I have abnormal stools too (sometimes oily, sometimes mushy, sometimes hard) which, among other things, I ascribe to poor fat absorption. And of course gaps and PHD emphasizes the importance of fat consumption. What do you think, am I on the right track (by going against the anti-fat diet that Gilbert’s patients are told to follow), is this the sign of die-off reaction, or the slowness of my metabolic adjustment to the new diet. I would greatly appreciate your feedback, it would mean a lot to me.

  6. Hi Paul,

    I am dealing with osteopenia again after bringing my bone density back to normal using a boron complex product (vitamin d, calcium, magnesium, zinc, copper, manganese, boron and betaine hcl).

    Knowing your views on calcium, I am hesitant to take the 1000/500 mg. calc/mag dose that I took before. It did, however, work!

    Strontium Citrate has been gaining some attention in the treatment of osteoporosis, and people are getting results. To take it, however, you must take the larger calcium dose.

    I’d like to try it. Is it worth the risk to turn my situation around again?


    Hi Mary,

    Yes, go ahead and take it. I would recommend adding vitamin K2 (to control ectopic calcification) and enough vitamin A (liver, egg yolks; if you don’t eat liver, 1 tsp cod liver oil) to the mix.

    Best, Paul

  7. Why the “prohibition” on flax seed and/or chia seed? Are they both “grains” and therefore bad? And can’t most of the toxins you refer to in grain and legumes be neutralized by cooking? The agglutinins are proteins which wold be denatured n boiling water.

    Hi David,

    They’re not prohibited, but use them in moderation. They’re seeds not grains. As such they have toxins but not necessarily specifically mammal-directed and therefore low doses are acceptable.

    Some grain and legume toxins are neutralized by cooking; this is why rice is safe. But many are not.

    Best, Paul


    Hello Paul,

    I was diagnosed yesterday with Crohn’s disease. I have been reading your book because I am giving up wheat. My question is this, I have kidney stones and the doctor says that people with Crohn’s malabsorb fat which in turn causes the stones. The Perfect Health Diet recommends 65% fat. Do you recommend adjusting this and eating less fat? And if so, what do you replace it with?

    Thank you,

    Hi Amy,

    You might want to read this post for some risk factors for kidney stones: http://perfecthealthdiet.com/?p=1177. It’s important to maintain antioxidant status.

    Crohn’s patients do have a higher rate of kidney stones but it’s not clear that fat malabsorption is the primary cause. One paper notes: “Unabsorbed bile salts and fatty acids in the colon lead to increased absorption of oxalate in the colon (Dobbins & Binder, 1977)”; calcium oxalate stones are about 2/3 of stones in Crohn’s patients.

    However, this paper suggests low magnesium and low citrate as primary causes: http://www.ncbi.nlm.nih.gov/pubmed/18060273. Definitely supplementing magnesium, and using lemon juice in cooking, is a good idea. Raising urinary pH (less acidic, more basic) also helps; potassium citrate supplements do that.

    In general, any gut dysbiosis may lead to increased oxalate absorption, since probiotic flora metabolize oxalate. Antibiotics lead to oxalate absorption and excretion, visible as beeturia from eating beets. So a disturbed flora in Crohn’s may easily be responsible.

    Among drinks, water is the best at preventing stone formation; black tea, caffeine, grapefruit and apple juices may promote stone formation. Among foods, you may wish to avoid high oxalate foods. An oxalate list can be found on the
    Web site of the Oxalosis and Hyperoxaluria Foundation (http://www.ohf.org/diet.html).

    Personally, I would not alter my diet much because of the Crohn’s, other than to reduce oxalates and increase water and lemon juice, but I would take extra care to be well nourished in micronutrients, take extra salt and water to help the kidneys work, and get plenty of magnesium, lemon juice, potassium, and antioxidants. If you see evidence of fat malabsorption (eg steatorrhea), then consider supplements of pancreatic enzymes, bile salts, and bile supports such as vitamin C and taurine.

    Best, Paul

  9. Hi Paul,

    I’m just doing my supplament shopping online and am wondeing which Selenium to get – if selenomethionine isnt well absorbed should I go for the yeast derived ones? I usually avoid yeast based stuff (I’ve even cut back on my marmite consumption!)since the last thing I want is a fungi problem. I can’t get the ones you recommend in the UK so would be choosing between Solgar yeast or non-yeast ones…..which would you suggest?

    Thanks for the awesome book and website!


    Non Yeast:

    Hi Carole,

    If choosing between those two I would take the yeast one, as I think it has a mix of selenium forms. Here’s an example of one we recommend that has a mix of selenium forms: http://www.lef.org/Vitamins-Supplements/Item00578/Super-Selenium-Complex.html.

    Best, Paul

  10. @Carole

    If you want another UK-based option – I get most of my supplements from nutricentre.com. They stock a lot of Kirkman products which are renowned for products free from pretty much all the usual fillers.

    The one problem I find is that the nutricentre website doesn’t have a lot of the detailed information about ingredients etc. and I often have to cross-reference with the kirkmanlabs.com website to find out the full product details before ordering from the nutricentre.

  11. A question about Epsom salts for getting magnesium…

    Would soaking feet or hands only provide enough magnesium absorption? Or does the whole body need to be exposed to it to really make a notable difference?


    Hi KH,

    As far as I know it’s not known how rapidly magnesium is absorbed transdermally. Soaking hands or feet only should work, but may require significantly longer.

    Best, Paul

  12. Hi Paul,

    I wrote to you back in August last year with a question on my lipids. At that time my tc was 360, ldl (Friedewald) 250, HDL 77 and trigs 62. I’ve since followed PHD with all the supplements but recently cut back on the Iodine as feared it was contributing to insomnia (I worked up slowly from 500mcg to 1 prolamine by Jan but since cut back to 500mcg to see if it would help with the insomnia which I think may be more related to my mind than Thyroid status!). This prompted me to get my Thyroid tested. I’ve been monitoring TC, HDL and trigs using cardiochek with the following results:
    15.09.11 TC 345, HDL>85 (max measurement on device – assumed 90 for all further as below), Trigs 59, LDL (Iranian) 196
    2.10.11 TC 306, HDL>85, Trigs 59, Ldl 168
    15.10.11 TC 334, HDL>85, Trigs 71, ldl 199
    3.11.11 TC 310, HDL >85, Trigs 74, ldl 179
    25.11.11 TC 317, HDL>85, Trigs 80, ldl 188
    1.02.12 TC 317, HDL>85, Trigs 58, ldl 177

    The results of my thyroid panel taken 29.1.12 were:
    TSH 1.27 mIU/L
    Free Thyroxine 17.1 pmol/L
    Free T3 4.1 pmol/L

    Do you think I should try and build up the Iodine again? I’m still a bit concerned about the lipids and would be really interested to hear your views. Is there a risk you become dependent on taking Iodine if you slowly build up? Feel great otherwise.
    Once again Paul & Shou-Ching thank you so much for all your wonderful work.
    Best, James

    Hi James,

    I think it would be fine to build up the iodine again, but you have no obvious signs of iodine deficiency so I don’t think it would necessarily affect the LDL number.

    What is your carb intake like? Get at least 400 carb calories per day from safe starches, more if you exercise.

    Best, Paul

  13. Hi Paul,

    I’m hypo and about to start the iodine protocol. My multi has 200mcg selenomethionine. If I also take 200mcg of the yeast-bound selenium you recommend over selenomethionine, would that be a toxic amount of selenium? I read elsewhere on your site that the tolerable upper intake is 400mcg. Cutting it close…perhaps too close?

    Thanks so much!

    Hi JW,

    Yes, I think it’s cutting it too close. Also I would try to keep selenomethionine under 50 mcg. So maybe change multis and adopt a selenium supplement? My multi has 55 mcg selenium I believe, and I take a 200 mcg supplement.

    Best, Paul

  14. Hello Paul or anyone else who can answer this, I know I must have seen this somewhere but can’t find it – how do calories of starch equate to grammes of starch ie how many grammes of starch in 200 – 400 calories. Thank you.

    Starch digests entirely to glucose, which has four calories per gram. But starchy foods have water, fiber, and other components besides starch. http://nutritiondata.com can tell you the amounts of calories in foods.

  15. Just realised that I misphrased my previous question, apologies. What I meant is, how many grammes of glucose are there per 100 calories of starch, thank you.

    Hi Frances,

    I assume you mean how grams or calories of glucose in 100 grams of a starchy food. It varies with the food; the best thing to do is look up the foods you are interested in at nutritiondata.com. A few examples:

    Cooked white rice: 130 glucose calories / 100 g (http://nutritiondata.self.com/facts/cereal-grains-and-pasta/5718/2)
    Potatoes: 74 glucose calories / 100 g (http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2770/2)

    Best, Paul

  16. HI Paul,

    I have been following PHD loosely (not started all supps yet) for about 3 weeks. Chronic sinus type headaches have gone, thankyou.

    Indigestion (that I had severely throughout pregnancy 3 years ago and has lingered) has worsened since starting the diet. Have not yet started on the fermented veg yet, but have been taking probiotics.

    Hi Shelley,

    Congrats about the headaches. What are the symptoms of indigestion? Acid reflux? Stool changes, gas, bloating, noise?

    Gut dysbiosis often takes time to cure. You’ll have to go through an experimental process to find which foods stir it up and which don’t. You may be eating more fiber now and that could be the trouble. Or more starches. Some people do better on starch, some on fruit/sugar. Some with more fiber, some with less. Some do poorly with certain types of sugars (FODMAPs). A first step is to find foods that supply your needed nutrition / carbs with minimum symptoms.

    Then, work on re-shaping the flora with yogurt, fermented vegetables, digestive aids (enzymes, betaine hydrochloride maybe, perhaps more salt).

    Optimizing vitamin D and A will help.

    Best, Paul

  17. Hi, Paul – Sorry, I don’t recall what you say (another unresolved symptom!!) about canned fish (such as salmon and sardines) but I know that many of the paleo writers recommend, for example, certain brands of wild pacific caught salmon. I ran across this paragraph on the GAPS website:

    “It is best to avoid processed foods (any packet or tinned foods). They are stripped from most nutrients that were present in the fresh ingredients used for making these foods. They are a hard work for the digestive system and they damage the healthy gut flora balance. On top of that they usually contain a lot of artificial chemicals, detrimental to health, like preservatives, colorants, etc. Try to buy foods in the form that nature made them, as fresh as possible.”

    Thinking as one who is not on the GAPS diet but does want to avoid foods deemed to be damaging or worthless, should I think that quality canned fish was an exception to what otherwise I’m sure is sound advice?


    Hi Allan,

    Canned fish is better than no fish, but not as good as fresh or flash-frozen and sealed. There are divergent opinions on how dangerous chemicals like BPA are, at the levels found in canned food. I am not really expert in this matter.

    Best, Paul

  18. Floored by your prompt reply. Had a big ah-ha moment when I heard your interview with Dr Mercola (just listen for the gold- Emily Deans take note). I went straight to your site and bought your book.

    Indigestion, dull ache in stomach accompanied by lots of burping, post PHD.
    Hubby noted to some German tourists that I burped at loudly when heavily pregnant “that’s how we say good morning in Australia”…

    I’m a chronic allergy, sinusey, headachey, chemical sensitive type. Had a year of repeated URTinfections carrying on for most of the year gone after our house flooded, and with a two year old Typhoid Mary carrying every kinder bug home. Hoping PHD will get me better and back to productivity.

    You and Sou-Chings integrity shines through, work like yours will help turn the tide. Will keep you posted if further improvements,

    Cheers, Shelley (RN and Midwife ICU)

    Hi Shelley,

    Thank you!

    Flooding often leads to mold and environmental fungal toxins. If the allergy/sinus/headache type symptoms come back, you might try testing charcoal or bentonite clay (or prescription cholestyramine, at a below-normal dose, maybe 1/5 the prescribed level for cholesterol reduction) to see if they relieve symptoms. All of these help excrete fat-soluble toxins like fungal cell wall components, which can recirculate with the bile and cause chronic immune symptoms.

    Best, Paul

  19. Thanks so much for the response Paul. My safe starch intake is probably closer to 300 so will try to push above 400 and report back in due course. I do exercise but not excessively – walk c.1hr a day and one session of Doug McGuff’s HIT workouts in the gym every week. Do you think the LDL number is something to be concerned about at 170-200 given the good HDL / Trig ratio? I have a high quantity of fat in my diet in the form of coconut oil, cream, some cheese but my reading of your work suggests this is not responsible for the high ldl. Btw just thought I would mention my kids are particularly appreciative of your creme brulee recipe!

    Hi James,

    I don’t think it’s overly concerning. Everything’s perfect except the LDL, and that’s high but not alarmingly so. Total cholesterol looks worse than it is because of the high HDL. Still, you’d like to find and fix any deficiencies leading to the high LDL. I think more carbs is the logical next step.

    Glad to hear about the creme brulee! Which reminds me, we need to make that again.

    Best, Paul

  20. Paul, do you see autoimmune or leaky gut as a possible root cause of my 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.

    Hi Jonathan,

    I don’t know what’s causing your collection of symptoms — usually there are multiple causes — but we tend to think that malnutrition, toxins, and pathogens are at the root of ill health and therefore the four steps of our book will generally improve almost everything. So I would start by trying our diet and supplements, and see if things get better.

    Best, Paul

  21. Hi Paul.
    Thanks again for all of your work. For those of us that appear to have high LDL partially due to not consuming enough carbs… Once we make sure we get in our 100-150grams of carbs (extra when exercising). Is intermittent fasting every couple weeks still OK? Is the 16 hour daily fast still preferred if we get all our recommended carbs in the 8 hour window or is it better for the high LDL due to low carbs folks to avoid one or both of the above.

    Hi BG,

    I don’t know the answer to that. I would say if you feel good while fasting, then it should be fine; if fasting is difficult, then I wouldn’t do it.

    Best, Paul

  22. Thank you yet again Paul.

    I had a 6-day run of managing a sweet potato every day, more bloated and slightly achey but also more energy and felt better. Then the AS and fibromyalgia flared up suddenly and also one eye started aching so have stopped the starch (don’t want iritis again) and am back to the drawing board trying to optimise glucose and minimise fructose intake from fruit and veg.

    I’ll retry clear (as opposed to brown)rice syrup when everything has settled down. However, it contains oligosaccharides and maltose as well as glucose so that may be the reason I didn’t tolerate it first time around.

    Which would leave dextrose. Has anyone out there with corn intolerance/allergy managed to successfully use dextrose as a substitute for starch?

    Thank you.

    Hi Frances,

    I do think dextrose is a good idea. Let me know how it goes.

    Best, Paul

  23. molly ryan-fisher

    I came to your plan by way of the “paleo” diet. So I tend to be meat heavy in my meals – I don’t trust myself to eat to taste yet. And natural foods don’t have the calorie breakdown that processed packaged foods do.

    Could you clarify what 200-400 calories of protein looks like? Could you provide some examples? Such as a closed fist size of meat (precooked), or 4 eggs = 400 cal

    And the same for carbs – I am a long distance runner and I crave starches (rice, potatoes, coconut). So would 1 baked potato, a 4 oz. serving of rice (uncooked or cooked?), a handful of berries (dried or fresh) = 600 calories?

    Thanks I have never felt better!

    “Protein should be a modest fraction of daily calories — 200-400 calories — but eat to taste.

    Daily carbohydrate intake should be 400-600 calories, primarily from starches (e.g., rice, potatoes, sweet potatoes, taro), fruits, and berries…”

    Hi Molly,

    The best way to develop your knowledge is to buy a kitchen scale and try measuring some of your favorite foods, in the amounts you usually eat, and looking up their nutrient content at http://nutritiondata.com.

    Some of the examples you ask for:
    Eggs: 1 egg has about 6 g protein = 24 calories, so 4 eggs = 100 protein calories, 200 fat calories.
    Meat: In general 1 lb meat has about 500 protein calories, so 200-400 calories per day would be 0.4 to 0.8 pounds of meat.

    Most of the safe starches we recommend are 300 to 600 calories per pound, eg cooked white rice is 600 calories per pound due to its high water content (vs 1300-1500 calories per pound for wheat products). So 400-600 carb calories per day corresponds to about 1 lb safe starches. Fruit tends to have about 200 calories per pound, as do sugary vegetables like carrots.

    As a long distance runner you may need to increase carbs further. Running may use up to 400 carb calories per hour.

    Best, Paul

  24. Hi Paul,

    I am 30 years old and I have always had stomach issues ever since I can remember, bloating, abdominal pain and constipation. I was told for years I had IBS, and just to increase my daily intake of fiber. I then had an endoscopy June 2010 which revealed I had Celiac Disease. I thought it was such a relief that I finally knew what was wrong with me! However, it’s been a tough year and a half after this diagnosis. I immediately eliminated all gluten from my diet, but substituted it with lots of other grains, including rice and corn. I was ok for a few months, but never really got rid of all the abdominal symptoms I experienced. The problems then began to switch from abdominal, to other systemic types of inflammation such as skin rashes, always being cold, fatigue, vertigo, skin temperature sensation issues. I really felt like I was losing my mind! So, this past summer, July 2011, I saw a neurologist who did an MRI of the brain. The MRI revealed inflammatory changes in my brain, white matter lesions. I was put through the entire MS work-up, and was then told by another neurologist that is was not MS, and possibly another auto-immune process that I had. I have since had a repeat MRI which has revealed no further advancement or addition of the white matter lesions. I am in the process of waiting to see a rheumatologist to R/O another autoimmune disorder in addition to Celiac Disease. In the meantime, I saw a chiropractor who suggested further food sensitivity testing. The results came back elevated for most grains and dairy. So in October 2011, I began to eliminate all dairy and all grains. I have since tried to follow the Paleo diet, with a few exceptions, including occasional hummus and dark chololate. My symptoms that I experienced have reduced, including the constipation, which I NEVER thought could happen! However, I am beginning to experience abdominal bloating and frequent foul odor gas. So my question to you is, am I doing the right thing by following this type of diet? I would like to try your diet and reintroduce a few foods like dairy and rice back in to my diet in limited quantities, but I fear that my symptoms will come back. My biggest fear is that I am eating something that has triggered not only an immune response, but has caused the neurological damage as well. I wish I knew how to pinpoint the culprit, in order to reduce ongoing inflammation. Thank you so much for listening to my story, and any feedback would be greatly appreciated!

    Hi Melissa,

    Well, clearly you have a gut dysbiosis (basically, infection of the gut with inappropriate bacteria or other pathogens). Gut dysbiosis can induce autoimmunity, which usually disappears ~6 months after the dysbiosis is cleared; so can wheat; but another possibility is an infection of the brain, gut dysbiosis makes the gut “leaky” and allows pathogens to infect immune cells which carry the infection elsewhere, including to the brain. So I think we have to consider your situation as a known gut dysbiosis/infection and a possible brain infection. The brain issue is slowly progressing, which could mean that eliminating wheat eliminated the autoimmunity, but could also just mean that you’re eating healthier now and the neurons are no longer dying.

    I would focus on the known gut dysbiosis and start by trying to detect pathogens. I generally recommend this test: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology

    If something is discovered then appropriate antimicrobial medicines should be taken.

    In the meantime, eating so as to improve the gut flora is desirable. You might read our bowel disease series (http://perfecthealthdiet.com/?cat=47), old posts first, and look at our fermented vegetables recipe: http://perfecthealthdiet.com/?p=5165.

    It’s good to get some carbs, but you have to find the source that is tolerable. The most tolerable are simple glucose-based sugars, as in dextrose powder, rice syrup, or tapioca syrup. In extreme cases you may be forced to get carbs from those. But see if white rice, which is fairly benign, is tolerated; or fruits or honey.

    I suggest eating coconut oil and doing intermittent fasting. You might look at our ketogenic diet series (http://perfecthealthdiet.com/?cat=15). Ketosis, at least intermittently, is good for neuronal health and brain recovery.

    It’ll take a bit of experimentation to find the diet that works best for you. Work off the dietary advice in our book but tweak it to the right level of carbs/ketosis and right food sources for you. Be sure to supplement micronutrients and eat nutrient-dense foods to become well nourished.

    Let me know how things go.

    Best, Paul

  25. Hi Paul,

    I’m about to undergo a colonoscopy to (hopefully) find out why I’ve been experiencing bloody and loose stools for the past 8 months.

    It’s just occurred to me that I have a good opportunity to repopulate my bowel with some good bacteria once I start eating again.

    Would you care to give me some suggestions as to what I might want to eat/avoid.

    I’m in my 40s, never had bowel issues prior to this. I avoid grains for the most part. I’m also overweight.


    Hi HM,

    It’s mostly just eat a good, healthy diet, plus a few fermented foods like yogurt and mixed fermented vegetables to provide probiotic flora. The food you eat will bring in bacteria, and over time the gut flora will adapt to the food. Good food = good gut flora in time, though it can take several years for everything to stabilize.

    So eat in accord with the PHD Food Plate. Also, I would take nutrients for extracellular matrix: vitamin C, eggs, bone broth.

    Best, Paul

  26. Deedee Ricketts


    I downloaded a sample of your book from Amazon and enjoyed it very much. Especially the “Perfect Health Diet Food Plate” apple.

    So, I decided to buy the book from Barnes & Noble (they could deliver faster than Amazon). However, no labeled “Food Plate” 🙁

    So, I decided maybe the Amazon book was different…it just arrived. Again, no labeled “Food Plate”.

    What gives??? When I “take a look inside” on Amazon…there it is!!

    Please explain!!

    Thank you.

    Hi Deedee,

    The food plate made it into the Kindle/ebook edition but not the print book, which went to print before we made up the Food Plate. Amazon’s “look inside” feature is based on the Kindle text.

    I’m going to do a new version of the free “Color Companion” which will have the Food Plate, plus all the book images in high-resolution color, plus the errata and index. It will be downloadable from the site. You can also get the Food Plate immediately as a jpg image from our “the diet” page.

    So I hope that will satisfy you!

    Best, Paul

  27. Hi Paul,

    I wanted to thank you kindly for your response. You are the first professional who has listened to my story and had an answer that makes absolute sense. I just purchased your book and cannot wait to start the healing process. I do have one more question, my husband and I would like to start a family. How does the healing process of the gut relate to pregnancy, and do you have any recommendations regarding when to begin in relation to the diet? Thanks again for all your help!


    Hi Melissa,

    Well, there are two issues: your ability to be well nourished during pregnancy, and avoiding spreading an infection to your baby.

    You will definitely need some carbs during pregnancy, so you will need to find a tolerable carb source, but as long as you can do that there’s no reason you can’t be well nourished. Gut problems often impair nutrient absorption, so eating nourishing foods and supplementing will be even more important for you than most. But it shouldn’t be a problem as long as you take care to eat well.

    The infection issue is tougher to judge without a diagnosis, but the body is pretty good at keeping most pathogens out of babies until birth, so I would say that if you feel healthy then you should go for it. Sometimes gut pathogens are also present vaginally and they are picked up by the baby during birth. Also, sometimes treatments for infections can affect a baby. So ideally, you would get diagnostic testing done quickly and get past any treatments that might affect a developing baby. You will have to discuss that with your doctor.

    Best, Paul

  28. Hi Paul,

    Quick question about a symptom I’ve been having for a couple months now. I’ve been feeling something like vertigo almost daily– it’s not all day long, but probably most of the day. It’s not severe though– it doesnt make me nauseous or fall or anything– but it is very noticeable and I’ve never had this before. I read Melissa’s comment above and was wondering if my vertigo (I dont know what to call it– sometimes it feels like I’m moving, ever so slightly) might indicate a brain infection?

    I am going to try to get my doctor to order the metametrix test, but I dont know if he will– he is very frustrated with my taking my health into my own hands. I want to say, “sorry to offend you, but it’s my body.” I’m sure this is common for a lot of us… tough situation.

    So, any thoughts on what could be possible causes?

    Here is my diet profile:
    – no wheat, corn, legumes since Oct 2011
    – no veg oils (corn, soybean, canola, etc) since Oct 2011
    – no sugar (no table sugar, no honey, no sweetener) since Oct 2011 (except a christmas slip… some candy)
    – a lot less fruit since Jan 2012 (replaced mostly with glucose tablets for blood sugar lows) still eat bananas, berries or apple occasionally
    -cut out cows milk products a few weeks ago (not 100%)
    – a week ago I cut out all dairy (i have had yogurt though a few times)
    – a week ago also cut out egg whites (now I just put the measly bit of egg yolk on my morning potato)
    – daily multivitamin, most days either 500mg or 1000mg extra vitamin C, few days a week 1000 IU Vit D3. occasional probiotic pill.

    The dairy and egg elimination was just to see if my stools would become normal. They have been maybe 85% improved over the months, but still had occasional diarrhea or very loose stools.

    Side note– by the way, my blood sugars have been amazingly stable more than ever before, I am incredibly delighted! If I had not stumbled upon your site, this would not have happened (I never read about paleo, I’m not from any diet, I just kinda stumbled upon this, and I’m so glad! thank you, thank you!!)

    Any thoughts would be so appreciated!
    Thank you kindly,

    Hi KH,

    Well, I don’t know. Vertigo can have so many causes, in the ear, in the nerves, in the brain. It’s hard to say what might be causing your case.

    There are some indicators you can use to check for brain infections. First, bacterial infections will tend to generate symptoms of hypoglycemia and serotonin deficiency. You can look those up in Google. If drinking a glucose drink makes it go away, it could be a sign of a hypoglycemic effect; if your blood sugar is not low when that occurs, then it might be specific to the brain and infection-induced. Also if antibiotics relieve the symptoms, that would indicate a bacterial infection.

    Before I thought about infections I would focus on micronutrients. I think supplementing magnesium is extremely important; it’s too bulky for multivitamins so they don’t have it. Selenium also, and a bit of iodine. Then zinc and copper. Also, I think you can take more vitamin D, and a bit of vitamin K2 which is helpful to nerve myelination.

    Then there is the gut infection, which I would continue to address. Circulating pathogen toxins or immune cytokines might cause the vertigo. So continue trying to heal your gut.

    It seems like it’s worth spending 3+ months on those steps before pursuing infection possibilities.

    Best, Paul

  29. Hi,

    would you also count borderline personality disorder to mental health disorders like depression, psychoses…? It’s just because of the ketogenic dieting-thing.

    Thank you very much


    Hi Jasmin,

    I have no idea what causes borderline personality disorder, but it wouldn’t do much harm to try a ketogenic diet for a few weeks and see if it makes a difference.

    Best, Paul

  30. @HM, I’ve been satisfied with Natren’s Healthy Trinity probiotics in a capsule. I’m on low dose pulsing Doxy to keep my arthritis in remission, and Natren is part of my protocol to help keep my gut populated with beneficial bacteria.

    I’ve also used Natren’s Bifido Factor & Megadophilus, depending on whether I buy at a brick & mortar store or from Natren.com

    I also eat homemade yogurt daily.

    Good luck with the procedure!

  31. Ok, thanks Paul for your insights and perspective. I have been planning on getting more supplements, so I will work on that and hopefully be able to get a metametrix stool profile done soon. Then I’ll see how things go.
    Thanks again!

  32. I just had a quick question. Is there a possibility of a high-fat diet contributing to lymphatic sluggishness since this is the system responsible for the transport of fats?

    Hi Lara,

    I don’t know. I don’t know what causes lymphatic sluggishness, so I don’t know what would affect it.

    Best, Paul

  33. Thanks Paul, I got the yeast ones as you suggested. I have started taking Iodine so its good to know I’m taking the best option.

    Thehealthyhorse, thanks for the heads up, I will take a look at that website next time I do a big shop 🙂

  34. Sweeteners- IN the vent that one of us would like to sweeten up one of our dishes (say, rice), what do yup recommend? I expect NOT honey (fructose!), but maybe one of the Stevia products? I can imagine our paleolithic ancestors using that African plant to satisfy their sweet tooth. But what about xylitol? What would you say about that?

    Hi David,

    I don’t think honey is terrible, but my primary recommendation is rice syrup, tapioca syrup, or another pre-digested safe starch.

    Among zero-carb sweeteners, Stevia is OK, so is Xylitol. All of these are listed as suggestions on the recommended supplements page.

    Best, Paul

  35. A question about lamb heart.

    I have discovered that I like it very much, so much that I could eat it daily. Looking at its nutritional information, I cannot see any reason that this would be unwise (unlike liver, where one would need to be careful of too much vitamin A and copper). Am I overlooking anything?

    As always, thank you.

    Hi MM,

    Yes, I think you can eat as much as you like.

    Best, Paul

  36. Jasmin,
    I have BPD and am taking a very low dose of risperdal (same drug in higher doses used to treat schizophrenia). I have found that following the PHD diet (in particular, getting enough Omega 3 and not excessive Omega 6 and eating PHD “safe starches”, etc., eliminating toxins, taking all the recommended supplements, and doing the intermittent fasting (16 hour fast with coconut oil during the fast with 8 hours feeding) has helped me tremendously. I feel so much better now: better mood, more energy, happier, calmer, less anxiety, better able to cope with issues such as difficult people. Hard to say what helped me the most. I had pretty much eliminated the toxins while doing low carb except for the excess Omega 6 and not enough Omega 3. (I had been doing very low carb for many years and do now wonder if it actually made my symptoms much worse.) So give PHD a try. I highly recommend it.

    Thanks, anonymous, I’m glad it’s working for you!

    Best, Paul

  37. What a great place to find information. Thank you Paul for taking the time to answer my question and thank you Michelle for taking the time to wish me well and make recommendations! (I plan to follow both of your advice.)I’m not a big fan of yogurt but I can get it down. I love kefir

    I have to wait for a couple of weeks for my results (I’m not in the clear as I had polyp removal and several biopsies).

    In the meantime, I’m concentrating on good diet/supplements and just wanted to say thanks!

  38. Hi Paul and Shou-Ching,
    I am wondering what your thoughts are on Terry Wahls’ TED talk and diet (link below). She uses a paleo/PHD type approach, but seems to leave out starches and focuses a great deal on the nutritive content and quality of veggies, fruits and berries.
    It doesn’t seem like she takes supplements. Wondering what your take is on her suggestions and remarkable recovery.


    Hi JC,

    I commented on that in a past Around the Web. I think it’s fantastic; we need more dietary cures for MS and like diseases to get doctors, scientists, and the public to wake up. In general, I think low-glycemic-carb, well-nourishing diets are great for brain infections and degeneration. Intermittent ketosis promotes immunity and neuronal healing. Sunshine and vitamins A/D/K are important for proper immune function. She did a lot of things right.

    Best, Paul

  39. Hi Paul,

    I had a few questions regarding my personal health and diet:

    1) I have been following the Paleo diet for roughly 3 months, eating primarily meats, veggies, fruits and nuts. I find myself hungry all the time and constantly craving sugar, like dark chocolate or more fruit. Could this indicate some sort of a systemic infection? I previously had episodes of hypoglycemia which went away after the beginning of the Paleo diet, however, have seemed to slowly present themselves again.

    2) In your book you recommend avoiding the mixture of sugars with PUFA’s. Does this apply to cooking? Or would you also avoid foods like a mixture of fruit and nuts, for example: LaraBars, trail mix, eating an apple or banana with almond butter, etc…

    Thanks so much!

    Hi Ethan,

    Re (1), the only thing we know for sure is that you need to eat more carbs. Try eating 400 calories/day from safe starches and see how you feel.

    Re (2), I think it’s OK to eat trail mix. I would just remember the general principle and use it for meal and dessert design.

    Best, Paul

  40. Hi Paul, I made a comment awhile back about peeing at night as a result of protein. I was hoping you had forgot about it and maybe could provide some insight as this problem still plagues me:

    I edited the original post some:

    I have a problem with excessive nocturia, related to protein intake. I don’t remember having this problem when I first started paleo in June of 2010. It seems to have started or gotten worse last spring. I had some blood work and a urinalysis done for this problem through my GP and they said everything was normal.

    My Experimentation has determined this:
    If I eat as much protein as I want whenever I want, I wake up 4-5-6 times/night to pee.
    If I eat as much protein as I want but stop all protein consumption after 3, I wake up twice.
    If I eat moderate protein and stop consumption after 3, I wake up once.
    If I eat moderate protein and stop all carb and protein consumption after 3, I wake up once.

    I taper water intake after 3 and try to intake hardly any after 7. This is a problem for me because I don’t feel as good on high carb and don’t do well with nuts or dairy. Extremely limited food selection.

    25 years old, 6’1 165. Lift 2x/week, surf, and walk for exercise. Limited Stress. Been eating higher carb than recommended lately since there isn’t a ton food options when cutting out protein. I don’t have cheat meals anymore. I don’t tolerate nuts or dairy well, further limiting food choices.

    Thanks for any comment at all on any direction to go, I really appreciate it.

    Hi Kyle,

    I’m afraid I don’t know much about this problem. Have you experimented with increasing your salt intake? Sodium and chlorine are both needed to excrete protein, and if you get a sodium deficiency you will have to excrete water to maintain sodium balance. So try eating a teaspoon of salt per day, drink sufficient water, and see if that helps.

    Best, Paul

  41. Are well done grassfed meats safe to eat all of the time?I’ve been reading that raw is best,but that isn’t palatable for me.I’m trying to slow cook(crock pot) most of my dinners.I’m trying to only have eggs and bacon cooked in a cast iron pan.

    Hi Frankie,

    Gentle cooking is important, avoid very high temperatures / blackening. But it’s fine to cook the meat as long as you want in a crock pot or in simmering liquid, ie a stew.

    Best, Paul

  42. Just got your book in the mail yesterday, and would greatly appreciate some feedback on a few things.

    I’m 56, 139 lbs, workout and run.

    We raise our own chickens (meat and eggs) and ducks (meat). The chickens and ducks are raised on pasture and also feed fresh greens (clover, rye grass, millet, rape, chicory). The fed greens constitute about 50% of their diet.

    My wife and I have mammalian meat allergy (from tick bites).

    I eat a pretty healthy diet. No processed foods.

    Recent bloodwork:

    Fasting glucose 99
    Insulin 3.5 uIU/ml
    Hemoglobin A1C 5.5%

    Saturated 40.01%
    Monounsaturated 18.94%
    Polyunsaturated 40.39%

    AA/EPA Ratio 3.23
    Omega 3/Omega 6 – 0.33

    Chol total 202
    Trigl 45
    HDL 78
    VLDL Chol Calc 9
    LDL Chol Calc 115 High
    T. Chol / HDL 2.6

    1) How can I get my glucose levels below 85? I just bought a glucose meter, and my first 2 tests were both 89. 1st test after eating a snack of mixed raw nuts, pumpkin seeds, sunflower seeds and coconut oil. 2nd test before eating lunch. What should my glucose level be just before a meal or snack? How about 1-2 hours after eating?

    2) I’m very active, and rely on eating a lot of nuts to avoid losing weight. From skimming your book, I need to cut out the walnuts and pecans, and not overdue the almonds. I did not see anything on seeds in your book, and there was not an index in the back. I need some high calory easy snacks for between meals. Suggestions? Are pumkin seeds and sunflower seeds (both raw) OK?

    I don’t eat much pasta, rice, or white potatoes.

    The only bread I eat is Ezekiel bread made from sprouted grains.

    I do eat a lot of sweet potatoes that we grow on the farm.

    I’ve been adding abruzzi rye grass from the garden to my breakfast blender recipe, and adding to salads too. Eat a lot of collards and kale, about half of it raw.

    Your help would be greatly appreciated.


    Hi Bill,

    In general your diet and bloodwork sound excellent.

    First, your blood glucose and cholesterol numbers are just about perfect. There’s no need to reduce blood glucose, fasting glucose in the 90?s is perfect. What were the “Lipids” percentages measuring?

    Chickens and ducks are great, you could add some seafood from time to time. Olive oil and coconut oil are great.

    I think nuts or trail mix are fine for snacks, especially if you’re outdoors. Other portable snacks we use are boiled eggs and salt, or seasoned seaweed and rice, or fruit.

    The only plant foods you’ve mentioned eating are greens which have very few calories. I think if you add some rice and potatoes that will help with weight gain. But depending on your height, you may not need much weight. More to the point is, are you able to gain muscle with exercise? If not, you may be deficient in carb or protein.

    I assume your mammalian meat allergy rules out dairy?

    Without a fuller description of your diet it’s hard to critique it. What you’ve told me sounds good, except that some of the plants may be higher-toxin than is ideal, and some of the meats higher in omega-6. Do you supplement micronutrients?

    Best, Paul

  43. PS:

    Re oils, I have been using just olive oil and coconut oil for about the last 7 years.

  44. tnx paul, i have been all around your blog and not able to find it, can u pls send me the link or direct me to you comments? t u

  45. hi again,
    i just saw you posted the video, but didn’t see comments from you — what would be the problems with her diet? too many vegetables? not enough starch?

    Hi JC,

    With vegetable consumption comes toxins and fiber as well as micronutrients. At the amount of vegetables she eats, those risk becoming excessive. I’m not quite sure what her macronutrient ratio was, or quantities of specific micronutrients, so it’s hard to say how her diet might have been improved. From what I’ve seen her approach is quite good for MS, but maybe not perfect – at least it’s not precisely what I would recommend. But what is best for MS is a question that will ultimately be resolved empirically.

    Best, Paul

  46. Re my question & your answer on 07 Feb 2012 at 2:58 pm # Bill:

    The Lipids were part of the Omega Score blood test. I assume that they were measuring the relative percentages of saturated / monounsaturated / polyunsaturated fats in the blood sample on a % by weight basis. I can e-mail the full test results if you like, just e-mail me. It was done by a lab in Canada, through the Life Extension Foundation. I think it’s a fairly new test.

    My wife does cook wild salmon about once a week and shrimp every couple weeks.

    Do you see any problem with snacks that are a mixture of raw almonds, pecans, pumpkin seeds, and sunflower seeds? I had been including walnuts in that mix, but see from your book that I should delete the walnuts. I have started adding a little olive oil or coconut oil to the nuts, and then sprinkling with sea salt, cayenne powder and garlic powder. I will continue to use hardboiled eggs as a snack also.

    I had been trying to reduce rice as much as possible, but can easily increase that a little. We do have baked or mashed sweet potatoes several times a week. We grow a large plot of sweet potatoes every year.

    Other vegetables include arugular, collards, kale, carrots, broccoli, and in season green beans, snow peas, tomatoes, peppers. And garlic with most recipes.

    I suspect that the eggs and chicken and duck meat are higher in omega-3 than the average due to the diet they are fed. No soy. Fish meal for protein in the feed I mix on the farm. They are on pretty lush pasture, plus we cut greens to feed them every evening when they are locked up for the night.

    Right now I’ve plateaued with slow overhand pullups at 13 reps, and pushups at 50 reps. This is doing an interval run (Peak 8) and weights/pushups/pullups every other day (or every third day when I’ve been doing strenuous work on the farm). So I don’t seem to be building muscle quite like I would expect. How do I tell if it’s carbs or protein that’s lacking? An ND I see recommended Creatine Whey Glutamine on days I work out. BUN was 17; Creatine 0.82; BUN/Creatine Ratio was 21 (a little high).

    Micronutrients, yes. The Drs Data RBC Elements test I just had done showed Chromium at 0.0004 which was at the very low end of a normal range of 0.0003-0.0060. I have started to supplement with chromium polynicotinate. Also take NOW Glucose Metabolic Support with chromium and vanadium, and magnesium, selenium and zinc.

    I try to avoid cow dairy because of prostate issues, but do drink raw goat milk kefir when it’s in season and I can get it.

    What vegetables are high toxin? The raw collards and kale?

    Glad to hear that the glucose levels in the lower 90s sounds OK. What levels should cause concern both on the low side and the high side? I plan to track my glucose levels for a week to see what the range is.

    Many thanks for your book and this blog!


    Hi Bill,

    I wonder what the reference range is on the Omega Score Lipids panel. Saturated fat is about what I would expect but monounsaturated fat seems low and polyunsaturated fat high.

    The snack is OK but I’d recommend tree nuts and fruit over seeds.

    I think you might be too low carb and would benefit from rice or potatoes. It’s good that you eat sweet potatoes. Re carbs vs protein, it’s rare for protein to be too low, people usually get hungry if it is, and you have meat in your diet, so I think carbs are more likely to be low.

    Toxins – the most toxic plants are grasses/cereal grains and legumes. You mentioned rye grass and Ezekiel bread. I think rice and potatoes would be better.

    Micronutrients could be an issue, it’s worth supplementing a multivitamin, magnesium, selenium, a bit of iodine, and D/K2.

    In general I think you’re eating very well. So I’m not sure what could be preventing muscle gain, but a few minor improvements seem possible.

    Best, Paul

  47. Hi Paul,

    As a result of my wife getting diagnosed with Celiac disease last May(antibody test, not biopsy), I started researching healthy diets. At the time were eating a high carb diet with lots of whole wheat pasta and breads and my wife was having iron infusions periodically to combat her anemia.

    My research started with GCBC and led us to eat a fairly low carb diet for a few months. We both lost 5-10 lbs and plateaued. We both exercise a fair bit and found it challenging to run 10km and play sports on a low carb diet. With more internet research I discovered your site and think your philosphy and approach to diet makes the most sense to me. I particularly like your thoughts on eating nutrient dense foods to limit overall calories eaten.

    After I discovered your site and read your book we made the switch to adding safe starches back into our diets. I lost another 5 pounds and feel fantastic(I don’t want to lose any more weight). My kids are also leaner and more energetic. However, my wife who is eating a better diet than the rest of us(100% gluten free vs 90% for me and the kids) is gaining weight for the last three months.

    Based on what I know of celiac disease, my wifes intestines are still in the process of healing and probably can’t absorb all the nutrients from the food we eat. I notice that lately she(160 lbs 5’8″) eats more than me(6’5″ 195lbs) at dinner, which I assume is her bodies desire to get nutrients it needs. Do you have any thoughts on the best foods and/or supplements to help her gut repair and stop her weight gain?


    Hi Matt,

    She probably also needs to restore gut flora, which can take some time.

    I would focus on bone broths (minerals, collagen) and fermented vegetables (for gut flora). Then supplement for micronutrients. Otherwise I would eat a normal diet.

    A nutrient deficiency which can lead to weight gain when switching to higher fat intake is a choline deficiency. I would recommend that she eat 3 egg yolks a day for choline. Liver is another good source.

    Presumably her weight will stabilize soon. Extra appetite is normal for a time when the gut flora are disturbed, bacteria help us digest our food.

    Best, Paul

  48. Any thoughts on dry skin?

    I have these dry patches on and off, but when going PHD that went away mostly. Winter brought them back, more specifically really cold (15F) and dry weather for the last few weeks.

    Basically my hands and elbows look like I dipped them in flour and some flour got in the creases. My lips aren’t chapped though, which is pretty new to me.

    First winter on PHD 🙂

    Hi Wout,

    I don’t know what causes dry patches so I don’t really have any advice. The skin needs a number of nutrients – vitamin C, sulfur (broths made from bone & joint tissue is a good source), glucose, protein, polyunsaturated fat (so omega-3 may help), but probably you’re getting most of those already. I would think the lip chapping would have a similar cause, so it’s probably better, just not all the way there.

    Best, Paul

  49. Thanks Paul! I haven’t tried supplementing with salt, I’m excited to try it out.

  50. This is for Wout. I don’t know how Paul feels about other readers chiming in with nonPHD suggestions, but here goes: my wife used to have similar problems. The Naturepath had her take homeopathic Petroleum 30c and the dryness and cracked skin cleared up almost immediately. It was ‘just take 1 dose and wait for the results.’ It can be counterproductive to eat a homeopathic remedy repeatedly if it is not working the first time.

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