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,

    I was wondering if I have hypothyroid symptoms (fatigue, dry skin, cold sensitivity, sleeping lots and still tired, brain fog,etc.) and I consume about 1-2 cups of raw crucifers daily, could the goitrogens be the cause of all my problems? And If i was to stop this consumption, how long would it take for things to normalize–assuming that this pattern has been going on for many many months.

    Many thanks,

    Hi Lenny,

    Yes, they could. Why are you doing that? At least cook them, and even cooked I think you should eat less, and rotate which ones.

    I’m not sure how long it would take the thyroid to recover, but my guess is it might be fairly quick.

    Best, Paul

  2. *small piece of additional info.

    Whenever I tried taking a small dose of iodine (approx. 500mcg) during this time, my thyroid would become extremely sensitive and sore. Not sure if that adds any diagnostic criteria to the puzzle but thought I’d include it anyways.

  3. @Allan: Whew, tall order 🙂 I wonder if homeopathy works on someone who is utterly convinced it cannot be better than placebo…

    And then there’s the counter-indications: http://abchomeopathy.com/forum2.php/105862/

    So I really appreciate you taking the time to help me out but I’m afraid it’s not for me, sorry 🙂

  4. Hi Paul

    I wonder if you could either refer me to where I could find information to compare my recent blood tests with what you would consider an ideal range, or let me know how they measure up. I have converted from Australian to American measurements.

    Cholesterol 290 (noted as being high on my pathology report)
    Triglyceride 71
    HDL 104 (noted as high)
    LDL 170 (noted as high)

    These results are after about 2 months grain/sugar free before switching to Perfect Health Diet about 6-8 weeks ago.

    Many thanks

  5. Wout – (Paul, I’ll drop this thread after this note) While no one nowadays doubts the power of Placebo, homeopathy is probably most effective with livestock and children. I think you’d be surprised how many dairies, for example, use homeopathy to cure infected udders (homeopathy has no drug traces. If they treat with standard allopathic treatments, the milk from that animal can’t be used for days (weeks?)) Everyone who want to use homeopathy is probably well advised to work with a practitioner and not listen to anecdotal “silver bullet stories” like I shared with you. Thanks _Allan

  6. Paul – I hate to see myself becoming one of those Paleo people who asks for permission to fudge on the diet, but here goes. There’s a Thai restaurant in my town that I go to for lunch now and then. Winter finally seemed to hit here yesterday so when I went to that Thai restaurant the manager suggested that I have a “Japanese chicken noodle soup” that I used to eat whenever I had lunch there in the winter a couple of years back. I protested that I was off wheat and he said “Listen, I’ll get them to make it from the Pad Thai rice noodles” I hemmed and hawed and then said ok. It was sure delicious. I dont’ doubt that I ate more startch in that dish than I normally want to eat in a day, but do you think restaurant Pad Thai ‘rice’ noodles are “save starches”? (I do not have obvious problems with gluton.) Thanks, Paul -Allan

    Hi Allan,

    Yes, Pad Thai noodles are safe starches. Eat up!

    Best, Paul

  7. Hi Paul,

    Do you know if the asian sweet potatoes are truly part of the “sweet potato” family? I just learned that sweet potatoes are not part of the nightshades, which I’m very happy about because I’m speculating that I might have problems with nightshades. Sores on my tongue after eating a few pieces of chopped raw tomato last week and then sometimes my nose runs a little after breakfast when I eat a potato (of course it could be the egg, I dont know yet). Mainly in an effort to find out why I’ve been so dizzy for the past couple months on a regular basis, I’m going to see if it’s my daily potato causing me problems. But, I was happy to learn that I can have sweet potatoes instead (I dont know of any oxalate problems for myself, so that should be a good replacement for me).

    Anyway, just wanted to ask about the asian variety since we like those a lot better. And also, wanted to share my thoughts in case anyone else out there is having any similar issue.


  8. Hi Paul,

    I will eventually write a post and introduce myself properly, but it’s such a long story that it seems really daunting to try and get it all down on paper. In the meantime I’ve got a couple of thoughts percolating through my brain about chronic disease and how it spreads.

    Do you think it’s possible that blood donation spreads chronic diseases like MS, ME etc? In which case, if you suspect you have one you really shouldn’t donate blood should you?

    Also, I have what I think is a chronic brain infection that I’m working on. An ex of mine had depression, which in some people would seem be a chronic infection type problem. I start going out with him and get what is probably a brain infection (fatigue, brain fog and what I judge to be cognitive hypoglycaemia and serotonin deficiency ). After we break up he starts seeing a friend of mine and she promptly gets ME. Is it possible that this is one chronic disease spreading from person to person? I’m really hoping you’ll say that’s not possible and I’ve misunderstood something crucial because shortly after I started seeing my current boyfriend he got Chronic Fatigue Syndrome……am I now the Typhoid Annie of ME?

    Hi Carole,

    Yes, infections can spread through blood donation or organ transplantation or any kind of tissue sharing.

    Whether you should refrain from donating is a judgment call. In fact everyone has infections at all times, so if blood donors had to be infection-free, there could be no donation. White blood cells are the component most likely to be infected and they are removed before transfusion. If only a small number of germs are transferred, normally the recipient’s immune system can deal with it. However, if you are overtly sick, then I wouldn’t donate.

    It does sound like there is an infectious pathogen in your case and it has been getting passed around. I would definitely try antibiotics, as well as a good diet, to see if it responds.

    Best, Paul

  9. The Metabolizable Energy of Diets Differing in Dietary Fat and Fiber Measured in Humans


    Any guide for our diet we’d want to apply found here?

  10. Hello,

    We have a question regarding your PHD and losing weight. My mom, sister, and I would like to lose around 10-15 pounds as well as decrease our body fat. We are noticing that we are feeling better on the PHD; however, the weight loss and decrease in body fat has not happened and maybe their has been a slight increase. We are concerned about cutting our calories by too much as we have heard that it has detrimental effects on the thyroid. We are supplementing kelp into our diet for our thyroids and taking your recommended vitamin supplements.

    We have tried cutting calories in the past as well as increased our exercise to only have mixed results. In fact, one month our mom ran around 85 miles and didn’t see any change in her weight; however, we have cut calories before and have seen some effect but when we return to the amount of calories for maintaining our new weight, we end up increasing. For your info, our stats are:

    My mom is 56 and is 5’4″ and is 135lbs and is eating around 1700-1800 cals with a break down of fat/carbs/protein of 55%/23%/22%.
    My sister is 25 and is 5’5″ and is 130 and is eating about the same as my mom.
    I am 23, 5’10”, and 191 lbs and am eating around 2400 cals with a breakdown of 55%/23%/22%.

    We all are doing moderate to intense exercising around 3-4 days a week.

    Sorry for all the information. We would appreciate any advice or insight you may have regarding PHD and weight loss. Thank you again so much for your book and PHD.

  11. Hi Paul,

    I am struggling at the moment with a flare up of ulcerative colitis. I am taking your recommended supplements but was wondering if there was anything I shouldn’t take or cut back on during the flare. I am passing blood and didn’t want to take anything that would aggrevate that. Thanks.

  12. Hi,
    I had a quick question regarding recommended carb levels and exercise. You mentioned in the book that to achieve a good lipid profile, one should “keep dietary carbs below 600 cal/day.” Does this 600 cal mark apply to one hour of intensive exercise per day and if not, approximatley how much should a person increase their carb intake above this 150 g for an hour of exercise per day? I am interested in losing body fat but want to provide the proper nutrients for my body during exercise but do not want to raise glucose levels.

    Thank you very much for your time and really enjoying the book and blog.

    Hi Katie,

    High-intensity exercise can use up to 400 calories glucose per hour. Athletes should increase carb consumption to compensate for glucose they use in exercise. 400 calories/hour of exercise would be appropriate for runners or cyclists who work at an intense pace. Intermittent sports, like basketball or tennis or weight-lifting, would be significantly lower, maybe 200 calories per hour of exercise.

    Best, Paul

  13. HI Paul,

    I had a question regarding coconut oil’s presumed pro-thyroid effects. Supposedly, the beneficial effects of CO on lowering LDL are based on the fact that thyroid stimulation allows more cholesterol to be converted into steroid hormones and therefore reduces LDL levels. Any validity to this? I’m asking specifically to understand if coconut oil can help me with my hypothyroidism. Thanks again for any input!

  14. disappointed one

    If you’d like people to consider buying the book, you should allow the Amazon “search inside” function to show some highlights of it. Many of us have tried various similar diets and will not buy another book that might just be the same as one we have already tried. It is rather unempathatic of the authors to not allow a simple search inside the book for hightlights. And no, just reading testimonials does not substitute for this. I won’t be buying until I can get an idea of what’s in the book.

  15. Dear Paul,

    Latest test results in. Got free Testosterone and free T3 done as well this time in addition to lipids:

    TC: 360 (down from 396)
    TG: 74 (down from 89)
    HDL: 66 (down from 73)
    LDL (Iranian): 243 (down from 275)

    Free Testosterone: 16.5 pg/ml
    Free T3: 1.96 pg/ml

    I had made sure to eat at least 100g of carbs everyday the last couple of weeks and had to take time off from the gym because of back spasms. I also reduced my caloric intake slightly to account for the fact that I was pretty sedentary.

    There is a definite (albeit small) improvement in the lipids in a relatively short period of 2 weeks which makes me believe I can benefit from continuing to eat >100g carbs, possibly even more. Which brings me to my free T and T3 values. They seem low despite being within the reference range of my lab reports.

    Do you think the free T3 especially is low enough to be indicative of hypothyroidism? If so, do you recommend I eat more carbs? Also, I get 150mcg Iodine from my multi but not much else. Do I need to supplement?

    Recently came across this article where Chris Masterjohn talks about Iodine needs being raised when eating goitrogenic foods:


    Your feedback is always hugely appreciated.


    Hi Jarri,

    I don’t think low T3 necessarily indicates hypothyroidism; it might also be nutrient deficiencies, eg carbs, selenium, or others. I would try dietary and nutritional changes first.

    I do think it’s good to get more iodine than that. Try seaweed, but preferably not kelp, and shellfish. Then gradually work up to supplements. I think getting 1-3 mg/day is good, from potassium iodide preferably. But increase dose slowly.

    Best, Paul

  16. Hi Paul,

    I got lab results back from my doctor yesterday and everything looked good. My cholesterol did come up (which I was trying to do since it had been 176 total last year) to 206 (HDL-100; LDL-100) and triglycerides 32. Is there anything strange about the HDL and LDL being exactly the same? (I don’t know if that’s good, bad, or, we really don’t know…?)

    My Vitamin D levels came back low again. Normal range is 30.0- 100.0 and mine was 27.5. (I had only been supplementing 1000 IU most days, sometimes 2000.) So, my doctor gave me a prescription for high dose vitamin D (50,000 IU/pill). He said I could take one a week. I’m always tentative about quick, big jumps so I havent taken it yet. Instead, I took 7000 IU today just to test out a slightly larger dose first. I don’t know if 50,000 at once would be a shock or something…

    Also, my A1c was 5.7 and I think it might be even lower next time because my blood sugars haven’t been jumping as high. We were very happy about this! (While I can say that I do try very hard to keep my blood sugar in good range, I do credit the stabilizing of blood sugars to PHD and all the knowledge I’m gaining from this site and others’ experiences here.)

    My CRP was 0.13 which I think is very low. I was very excited about that (last year it was 0.17) until I read something this morning that made me wonder if too low could imply something negative? Too bad I can’t even remember what I read! 🙁

    What do you think about the Vitamin D dosage? Anything I might want to be careful with (balancing other vitamins appropriately) or watch out for?

    Thanks so much for your time! 🙂

    Hi KH,

    Congratulations! Your blood lipids and CRP are fantastic. HbA1c normal.

    I think for vitamin D, I generally wouldn’t counsel supplementing above 4,000 IU/day as a routine thing, so 50,000 IU/week strikes me as too much, except as a short-term thing to recover from a deficiency. I don’t think there’s anything wrong with taking a few 50,000 IU capsules if your D level is low, but I wouldn’t do that for long. In your case I think 2,500 IU/day sounds about right. If you’ve been averaging 1300 IU/day, then doubling the dose should bring your serum levels to optimum. So I might take 2 of the 50,000 IU capsules on consecutive days, then switch to 2500 IU/day for the remainder of the spring, with an eye toward reducing it as summer comes and you get more sun, then ramping back up in the fall and doing 2500 IU/day next winter.

    I think the reason he gave you a prescription for 50,000 IU is that that’s what’s available under prescription. It’s not that it’s the optimal dose, it’s the lowest available pharmaceutical / insurance-covered dose. You may find it’s cheaper to not fill the prescription and just get 2500 IU capsules, they’re pretty cheap.

    I don’t have anything else to recommend, except that taking including dietary sources of vitamin A (egg yolks, liver) and supplementing some vitamin K2 will assist vitamin D function.

    Minerals like chromium, selenium, iodine, magnesium, etc may support blood glucose regulation, but I assume you are taking those already.

    Sounds good!

    Best, Paul

  17. HEY PAUL
    so my daughters SHES 4, HER T3 3rd generation was 5.45 high and her T3 FREE was 3.3 low.
    We know she has gut dysbiosis and some form of SIBO and lots of yeast..
    how do we do the carb thing? If increasing her carbs would help thyroid, but worsen yeast?
    Thank casie

  18. Hi Paul-
    Thank you for giving us the research and information that we may better address health challenges.
    I have a bit of a challenge myself and any info you may be able to give is very much appreciated…I developed a rash around my fingers and back of hands,and while in the Philippines for 6 mo. last year I also developed a rash on and above my eyelids.I have used an otc cortisone cream and that clears it up,but it will later return…I bought your book in April and follow the PHD diet which has helped my weightlifting quite a bit but not the rash…Any thoughts on this apparently inflammatory condition and how to address it? the eyelid thing is a bit disconcerting.
    Thank you

  19. Hi Paul and Shou-Ching,
    Hope you are having a nice weekend. I have a couple questions.

    1. My husband has recently gotten eczema on his face. He is 38 years old and has never had eczema before. He is not on PHD. He exercises regularly. I read in an earlier post that eczema comes from an omega 6 deficiency which I don’t understand as I thought we all have too much omega 6 in our diets. Anyway, what are your recommendations for him?

    2. What does it mean if you intensely crave sweets and carbs in general?


    Hi JC,

    An omega-6 (actually arachidonic acid) deficiency is one possible cause of eczema. However, there are other causes too. There is plenty of omega-6 in all of our diets, but it is in the form of linoleic acid, an 18-carbon fat. In certain infections or situations of high oxidative stress, especially if antioxidants are deficient, AA can be destroyed faster than it is produced from LA. This is what leads to the eczema. The solution is to eliminate the source of oxidative stress and the antioxidant deficiency.

    Other types of eczema are poorly understood but involved a disturbed immune response (the AA deficiency is one way of perturbing the immune response). I would recommend an experimental approach, starting with vitamin D/A/K2 optimization and supplementation of the major minerals. He can experiment with vegetable oils to see if more omega-6 helps; if so then he needs to try to identify the source of oxidative stress, and supplement antioxidants. In general, healthy and nourishing eating is the first step.

    Cravings for sweets can have several causes, but in general it indicates that the brain thinks the body is short of glucose at that moment. This can be because the body really is short of glucose, due to an excessively low-carb diet; it could be that there is a transient hypoglycemia, which actually is more likely to develop on high-carb diets if glucose regulation is disturbed; or it could be that there is an issue specific to the brain.

    So, if you’re very low-carb try eating more carbs, if you’re very high carb try fewer carbs, try coconut oil to see if ketones help, consider getting a blood glucose meter to see if the cravings correlate with blood glucose levels.

    Best, Paul

  20. Hi Paul,
    I have a similar situation to what you had. Pretty sure its a severe fungal(candida) and oter yeast overgrowth in the large and small intestins. SIBO. I have a mild case of thrush, and a red patch on my leg that comes and goes.
    What is the best way to approach this via your diet? I cannot handle eggs, dairy, all of the typical offenders due to leaky gut..fructose, oaxalates..
    how did you cure yourself?

  21. Hi Paul,

    Thanks again. Yes, you are right. I am sure I can correct this through dietary changes alone and I never meant to imply otherwise. It’s just that the low free T3 value makes me think that the high LDL is due to a hypothyroid-like condition as so often talked about in the Paleosphere.

    I do believe I may not have been getting enough carbs on a daily basis and I am working on this by eating at least 100-150g per day now. Not sure about Selenium as my multi provides 200mcg. I don’t think supplementing with more would be wise, would it?

    For the iodine, I live in a place where I don’t have access to fresh seafood. I can get tinned tuna, salmon, kipper, sardines, anchovies, etc. but no seaweed or shellfish.

    I got kelp from a local GNC store once but even they don’t have a regular supply of it. As it is, you’re saying kelp is an inferior option so I’m not sure where to go for Iodine. I’ll check if I can get some sort of iodine supplement from the pharmacy. What would be a good dose to start with, considering I’m only having 150mcg at the moment?


  22. Hi Paul

    I realise it is must be increasingly difficult for you to answer all questions posted here, but would it be possible for you to tell me where to find information on ideal blood lipid levels so I can judge my recent results to see if I need to adjust my diet – and monitor any changes in the future.

    I have a past history of cancer and currently severe osteoporosis but feel sure I am now on the right track now with the Perfect Health Diet.

    Thanks again for all all your work.


    Hi Kay,

    You can read the Biomarkers > LDL/HDL/cholesterol category on our blog for background, http://perfecthealthdiet.com/?cat=140.

    But optimal levels are:
    TC, 200-260 mg/dl
    HDL, >60 mg/dl
    LDL, 80-160 mg/dl (depends on context, numbers in this range can be healthy or signify a problem in different situations)
    Trigs, < 90 mg/dl Best, Paul

  23. Paul,

    I’d appreciate your thoughts on the possibility of Botox injections into leg muscles (for spasticity) causing a gut problem.

    Botulinum A (Botox) is a metabolite of botulism that causes paralysis and possibly death if one is poisoned by ingesting botulism (in case anyone wonders)

    The injections mean the difference between walking and not walking; lots of pain and hardly any pain (it’s that effective on the spasticity).

    Not sure if the it works that way

    Hi HM,

    I don’t know why it would cause a gut problem. But your doctor would be the appropriate person to address this question to. I don’t try to understand risks or side effects of pharmaceutical therapies like Botox.

    Best, Paul

  24. Vit. D side effects?

    Hi Paul,

    When I take D3 in the morning, that night I will pretty reliably have sleep disturbances: strange, unpleasant dreams, bordering on nightmares; waking every hour; perhaps some brain fog; and sometimes being unable to get back to sleep.

    This happens with two different brands/forms: one a dissolving tablet, one in drops (both choecalciferol.) I’ve tried it at 2000IU and yesterday at 1000 and both have the same effect. This is in addition to 800IU in a multi, which does not seem to effect me when taken alone (although I sometimes may wake at night once or twice, it’s not accompanied by vivid, disturbing dreams or a feeling of unease — usually I don’t even remember dreaming.)

    A couple months ago I took D3 at 5000IU (plus the multi) for a few weeks, but can’t remember similar symptoms. I may have had a few nights with sleep problems, but if so I didn’t tie it to the Vit. D.

    I have not had my blood levels tested, so could I have high levels from the 5000IU days? It seems unlikely to me but I’m a novice.

    Some other things going on: I ended low-carb 5 or 6 months ago (after 2-3 months on it) after reading your “Dangers of Low-Carb” series. I have had some hair loss/thinning lately, which I think began during low-carb. I understand that might indicate hypothyroid issues?

    I began low-carb mainly to see if it would clear acne I’ve had since teenage years (I’m 33.) I think my skin has improved, and one big part may be almost cutting out dairy (other than a pastured butter.) When I add back dairy my skin gets worse.

    To my eye I seem to have that white coating towards the middle/back of the tongue that indicates some “bad bacteria”(?) problem.

    During the teenage years I had several winters with terrible chest colds (as a newborn/infant I had croup and was on an assisted breathing device) for which docs prescribed antibiotics (Primatene I think, maybe others) which may have killed gut bacteria..

    A couple years ago I had shingles(!) which was treated with antibiotics.

    I’m trying to follow PHD and am a huge fan of your articles and this site.


  25. Hi Paul,

    Quick question…….I love dark chocolate but cannot eat it because it is a never-failing migraine trigger. I can eat a small amount of carob in it’s place. Is carob a safe food?

    Thanks so much,

  26. Hi Paul,

    Several months ago you gave us much appreciated advice about baby solids – the twins are now nine months old, crawling flatout, walking holding on to things and eating solids enthusiastically. They have rice cereal and egg yolk for breakfast, banana for morning tea, rice cooked in beef broth for lunch, and potato, sweet potato or pumpkin mashed in chicken stock for dinnner. The smaller twin still get a rash around her mouth from runny egg yolk but can now tolerate scrambled or hardboiled egg yolk, yoghurt and occasional chewing on a piece of tough steak (which always used to result in mouth rash). She also rarely sleeps in the daytime, whereas the bigger twin tolerates all foods, sleeps well and has a very placid nature.

    The annoying mothercraft nurse is very unhappy with their diet and has recommended toast, pikelets and a brand of wheat biscuits and she has predicted speech problems if the babies are not given these foods, which she says require more chewing and can be held in their hands. My daughter would like to know whether you think they are old enough to try seaweed – sushi style wrapped around rice, egg and avocado. She also wondered whether pieces of cheese and vegetables such as broccoli, cauliflower and green beans would be OK at this age to hold in their hands and chew on. I’ve read an article by Chris Masterjohn about cruciferous vegetables and would query giving them at nine months of age.

    They have meat rarely but the mothercraft nurse insists that they now be given it more often.

    Thanks again Paul, I am incredibly grateful for your past help and for the babies good health in the last few months.

  27. Hi there,

    Thank you so much for all the support you offer. I have been following your diet for a few months and in many ways feel much better. Last year at this time I could barely walk (29 years old). I was diagnosed with Crohns along with several other autoimmune diseases (including a legion on the spinal cord). I’ve gotten cavities in every single tooth in the past year and they keep occurring. I should also mention that I have acid constantly in my throat – to the point that a legion has formed. If I eat any food with the slightest amount of sugar in it (carrots, squash, etc) my teeth react and stain. I thought rutabaga was safe but I will have to cut them out as well as they are causing a brown stain on my teeth. It seems that when I cut any foods with sugar content my teeth (cavities) and the staining stabilize. Do you have any thoughts on this. I’ve been brushing my teeth with baking soda and hydrogen peroxided but to be honest I’ve at a loss as I seem to have tried everything. Any help would be appreciated.


  28. Paul, I really appreciate your research and thoughtfulness regarding diet. Your book has been a great help to me in my attempts to find the right fuel for my machine. Thank you so much. Here’s my question.

    Sally Fallon states that soaking/fermenting grains inactivates phytic acid and makes them safe to eat, but the trend these days is to totally remove grains from a healthy diet. I am not clear on whether there is an explanation for why her view is considered incorrect. Could you clear this up for me? Feel free to direct me to any previously published material in your book or on the blog. I may not have put it together when I first read it!

  29. The PHD includes taking 8 daily supplements and a multivitamin. Some are fat soluble in which case it doesn’t make sense taking them on an empty stomach with an almost non-fat containing banana. Others interact negatively like copper and zinc or positively like K2 or Selenium with vitamine E. Out of interest, how do you take your nine supplements during the day? All in one go with your main meal or do you separate in time a zinc containing multivitamin from a copper supplement etc.

  30. Hi Paul,

    I was wondering if you knew of any additional dietary interventions to augment an already healthy diet, based on your PHD book principles, in order to deal with two problems I’ve been having: extremely dry skin(including severe dandruff) and oral thrush. Thank you for any time you can spare on the matter =)

  31. I would suggest you read all the recommendations Paul has given for fungal infections.

  32. where do I find them?

  33. It may take some time, but if you read through the Q and A it is mentioned a lot.

    Here is what he wrote me last year:

    (scroll down to May 11)

    Hope this helps.

  34. Hello, we bought your book a couple weeks ago and have started diet/new way of heating.Must say that the result of feeling better is worth the price of your research, thankyou.
    my question deals with added fiber, and how to get more fiber,to relieve a slight level of constipation, can you recomend a good food source?…

  35. I just watched Forks Over Knives.
    This led me to read your response to The China Study.
    But this was almost a year before the expanded book and doc. highlighting dramatic results with patients. Since these new publications are a serious development, I’m wondering what you make of them. Since it seems to argue for high carb, low fat, no animal protein, I’m sure we’d all appreciate a word from you.

  36. Paul, I loved the book and have been following the diet for a few weeks.

    I get intense brain fog and fatigue everytime I eat. The portion size, macronutrient ratio etc. does not seem to matter. Any thoughts on this?

    Thank you for taking the time to answer so many questions.


  37. Hi Paul or anyone else on PHD,

    I searched the site for recommendations for gallbladder issues. I’ve been on the diet for 3 weeks now and have recently experienced some discomfort in the upper right abdomen area. It’s very tender to the touch and have wondered if I should do something soon before the pain gets any worse. I’ve done a few searches online regarding natural cures for gallbladder pain or gallstones. Mostly what I come up with is the olive oil, lemon juice cleanse or some variation of this. I was wondering if anyone has any success doing this or if there is anything else I could try to get rid of the pain like take more of a vitamin or mineral? The last thing I want to do is have this organ removed. I’ve heard it’s very common to have it removed but could be very dangerous, too. Please, any help would be appreciated.

  38. Paul,
    I’m a 33 year old male who is moderately active. A 2.5 cm mass was found in my thyroid and confirmed to be papillary thyroid cancer. My Endocrinologist has recommended a thyroidectomy followed by I-131 treatment. Afterward they plan to prescribe synthetic T4 as my replacement hormone.

    What are your thoughts about health after a thyroidectomy? Specifically, how would you recommend the PHD and supplements be modified? Also what level of TSH would be a good target once I’m on synthetic T4?

    Thanks in advance,

  39. Nick, look up chanca piedra. It’s a herb also known as “stone breaker”, used to help break up kidney and gallbladder stones. If you do choose to do the gallbladder/liver flush note that mallic acid is said to help soften the stones beforehand. What that cleanse theoretically does is stimulate a strong gallbladder contraction due to the lack of oils beforehand, and then the sudden influx of fats. There, of course, exists the possibility of getting a stone stuck in the bile duct. Just be sure to do your research before you make a decision either way. Good luck.

  40. Dear Paul,
    Started with adding more carbs to my previously low carb high fat, medium protein diet (I think I was on 50-100 grams carbs a day, for about 10 years) after reading PHD. I have cut out grains for about 4 months. Since adding more carbs by way of potatoes, a little fruit like a banana, rice, I am suffering from what I think are hypoglycemea symptoms, something I haven’t had all these years whilst being low carb. My bloodwork has always indicated very good insuline/glucose levels (whilst low carbing). I am sure I need to add more carbs, as I have developed hypothyroidism, something I now think might be to do with a long time of too little carbs. Have you any suggestions on how to increase carbs but not ending up with ‘sugar’ shakes after 3-4 hrs? Thank you very much if you have time to answer,
    Kind regards from the Netherlands,

  41. @dusty, here is a critique of Forks over Knives by Denise Minger who also studied the China Study in great depth:


    It’s a long read 🙂 I can’t really do it justice summarizing it but I think it’s fair to say that the science is rather shoddy and the diet results he gets are also attainable (and more) on other diets (like the Perfect Health Diet 🙂 ).

  42. Hi Paul,
    I read your book and am a regular visitor of your site. I really appreciate all the valuable information you provide.

    I would like to ask what you would suggest for preventing tooth decay and possibly curing cavities.

    Unfortunately, my 5 year old son has many decaying teeth in his mouth. His diet was less than ideal before, but has become better lately. We try to follow a traditional diet with bone broths and fermented vegetables. We also give him probiotic supplements, which helped him.

    Thank you very much,
    Regards from Istanbul

  43. Hi Nick,

    I don’t have any knowledge or experience in this area, but I remember my mom doing the olive oil/ lemon juice cleanse several years ago. Unfortunately it was so long ago, I can’t remember the outcome for her, but it certainly didn’t harm her. Also, unfortunately, she eventually had her gallbladder removed.

    Maybe if I was having that pain, depending on how severe the pain was, if it were me, I might try both approaches– I would go to the doctor for use of their diagnostic tools (x-ray might be able to show gallstones, if they’re large enough) and see if bloodwork would be able to reveal any infection. If gallstones were seen on x-ray and they didnt appear to be obstructing the ducts, then I might go home and try the liver/gallbladder cleanse. Here is one site (I can’t vouch for the credibility of this site, but I do like the name of the site, that’s hopeful!) that shows two cleanses:


    However, note that they include taking Epsom salts internally. I don’t know if that’s a good idea. I think it can possibly do some damage, but I read that people used to drink a small amount to relieve constipation. Anyway, just a note of warning. I don’t know enough to say whether or not I would do that part. Maybe someone else here can chime in on that??

    After reading that gallstones can develop asymptomatic for years, I’m thinking my husband and I might even do a cleanse tomorrow (even though we have no symptoms). Apparently there can be hundreds or thousands of stones…?? I don’t know if it’s true, but that’s what I read.

    Maybe someone else with relevant knowledge will write soon.

    Anyway, hopefully you’re doing better. Good luck!

  44. Hey, Nick,
    I am a nurse who is very tenative about mainstream medicine, so I have knowledge tinctured with a lot of caution! I am not giving medical advice here, just trying to share information. (Notice I am actually very cautious!) If you have been on the PHD for 3 weeks, then your GB may simply be protesting the increase in fat intake. Fatty meals often cause GB pain if one is prone to GB problems. If I was having this pain, I would back way off the fat and see if it improves. Then, I would eat a fatty meal and see if the pain returns. You do need to pay attention and see an MD if it continues. You can have it diagnosed, which is noninvasive, but you don’t have to have anything done immediately unless you have a stone blocking the duct. If you do have a blockage, there is no choice but to have something done. If you don’t, your GB can get gangrenous which can lead to life-threatening illness. Generally, people know if this happens due to extreme pain, but you don’t want that let it get that far. People have stones that never cause problems, and people have extreme problems. There’s a spectrum with this, as with everything. Knowledge is power, so you do want to know what your options are depending on what is causing the pain. Be cautious, but be prudent. People live full lives without their GBs, but I understand that you don’t want to have anything done unless it is necessary. I hope this rambling has helped.

  45. Julie Lewandowski

    Your brain fog and fatigue after eating sounds like a food intolerance, not allergy.
    Check out salicylate intolerance, a good website and forum is alicylatesensitivity.com/forum
    Also check out the symptoms of oxalate, gluten, lactose, casein and amine intolerances.
    There appear to be 2 types of intolerances. One is due to leaky gut as that will allow food not fully digested to get into the body causing toxic reactions. The other happens without leaky gut but leaky gut makes it worse. This type is due to the body not making enough of the enzymes that metabolize these foods or specific compounds like phenols, salicylates–aspirin related compounds, lactose, etc. If the body lacks a critical molecule to making some of these enzymes, it won’t be possible to produce enough to detoxify the substance leading to a host of physical and mental symptoms. For salicylate intolerance, the PST enzyme needs bioavailable sulfur so epsom salts baths are one treatment that helps remedy symptoms.
    I react to certain high salicylate foods, drinks, flavorings such as mint, tomatoes, with brain fog, fatigue and a heavy feeling in my legs when walking. A stick of mint flavored chewing gum can within 30 seconds trigger the heavy feeling in my legs walking upstairs. My mood and thought can be strongly affected, becoming self critical and difficult to focus.
    I also seem to be responding to lactose, not to cheese or fermented milk like kefir/yogurt so it is not the casein proteins but the lactose sugar. Lactase, the enzyme in lactaid and other OTC dairy digestive enzymes is controlling it for me.
    But within 20 to 90 minutes of drinking milk before I tracked down the connection, I would get brain fog so bad my driving could be impaired for an hour, might become dizzy, nauseated, shaky, have gut cramps and have to wait it out until it passed.
    Keep a food diary for at least a week to see if specific foods make it worse. There is a cumulative effect that makes this worse as it may take a couple of days of eating specific foods to build up to your trigger level. But limiting high salicylate foods for a week might reduce your symptoms and give you an idea if those foods don’t work for you. Then go on to other classes of foods and see if limiting that helps.

  46. Hello,
    The bottom of my feet and the palms of my hands are orange. They have been like this for a while now (months or maybe a year or longer). Also I have a hiccupping problem. I hiccup everyday sporadically and loudly throughout the day on average of once an hour or every other hour. I eat very well so I cannot figure out what is causing either of these problems. Do you think it is food related? Thanks, Angela

    Hi Angela,

    As Connie suggests, the orange sounds like you’re eating a lot of carotenoids – eg carrots or other colorful (orange, red, yellow, green) vegetables. If you already get enough dietary vitamin A carotenoids won’t be converted to vitamin A, but stored in tissue. It should be harmless but you might want to avoid supplements with carotenoid or vitamin A.

    Andrew below suggests hypothyroidism as an alternative explanation. If you don’t eat a lot of colorful vegetables you might check for that.

    The hiccups is tougher. The Mayo Clinic lists these causes: http://www.mayoclinic.com/health/hiccups/DS00975/DSECTION=causes. The only likely sounding one is electrolyte imbalances. Wikipedia has a good discussion: http://en.wikipedia.org/wiki/Hiccup. They say either sodium or potassium deficiency may cause it and suggest eating “salt to normalize the potassium-sodium balance in the nervous system.” Perhaps you are not getting enough salt?

    Best, Paul

  47. Angela, I had that problem when I was getting too much vitamin A – supplements and eating lots of canned pumpkin.

  48. Angela,

    I say that as a symptom of hypothyroidism, like here:

    Dry or Discolored Skin

    An underactive thyroid gland can also cause dry or discolored skin. Dry skin can appear red or flaky and may become itchy or irritated. Skin discoloration due to hypothyroidism can cause your skin to appear yellow or orange–especially on the palms of your hands or the soles of your feet.

    Read more: http://www.livestrong.com/article/83620-side-effects-hypothyroidism/#ixzz1meyDOuEM,

    I was researching it for other symptoms I have, and noticed that my soles are a bit orange. I have been very low carb paleo for about a year (which I learned here at PHD can reduce thyroid hormones). I had intentions of eating sweet potatoes, but never got around to it….

    Thanks Andrew! – Paul

  49. Q: Huge blood pressure swings?

    I’ve noticed recently that my chronic borderline hypertension is radically changed with a glass or two of wine (or more). This seems contrary to most of the effects I can find on the internet. By radical I mean:

    Before wine:
    Systolic 130-140 or higher
    Diastolic 75-90 or higher
    HR 58-62 (kinda healthy low)

    After wine:
    Systolic 105-115 or lower
    Diastolic 48-50 or lower
    HR 68-72

    The relatively low resting heart rate seems healthy, but with fewer beats I guess it works harder or something? After wine, the heart heart goes up to a more “normal” level and pressures drop!

    I’ve been PHD for less than a month, coming from a solid year of VLC Paleo, and years of yo-yo conventional wisdom crap.

    I fear my former lipophobia turned towards carbophobia over the last year year resulting in some hypothyroidism. Seem to have a bunch of the symptoms. Any relation to BP changes above?

    I can also kind of relate to the discussions and articles here on PHD about possible brain infections and it makes me wonder if there’s something wrong in my head. I did 22 hr ketogenic CO fasts three times this week and didn’t notice a radical “brightening” of the world. Maybe I’m just innately irritable?

    Also read here about alcohol being metabolized in the brain and maybe somehow interacting with an infection. Any way to link a possible infection and alcohol to radical BP changes?


    Hi Andrew,

    This is something of a mystery. I guess I’d ask first if your blood pressure readings are consistent whether you are sitting up or lying down. Orthostatic hypotension is a possibility to look for.

    The other thing I would tend to is electrolytes and water. Make sure you are getting plenty of salt, potassium and water daily. I suggest mixing salt and “No Salt” which has potassium in a 2:1 ratio and liberally salting your food, plus eating vegetables, plus drinking plenty of water.

    If you’re normal you shouldn’t notice much effect from a ketogenic fast or diet. It’s when there’s a disease that you may notice an effect.

    I guess I would try to gather more data. Most blood pressure issues resolve fairly quickly on our diet and supplements, usually within a few months, so I would wait and see if things change. Vitamins D/A/K2 and the minerals magnesium, zinc, copper, selenium are all important for vascular health and blood pressure.

    Best, Paul

  50. Andrew,
    When are you taking your BP? A realistic BP measurement is taken after you are sitting in a chair resting for a few minutes, best done first thing in the morning. Everyone has variations in BP depending on recent activity, and your BP changes throughout the day. Actually all of your numbers look healthy. How old are you? What did you mean about the diastolic being 90 or higher? How high? And what were you doing right before you took it? I would be surprised if your BP didn’t drop after drinking wine and relaxing. It is normal for your pulse to go up a bit when your BP drops. Your heart has to pump a little harder to move the blood when your BP is lower.
    I don’t want to make you feel that I am minimizing your concerns, but you shouldn’t be concerned if your don’t “brighten” immediately with fasting. You may be overdoing the fasting, it’s a fine line, and you are fasting a LOT. I have been doing daily IF for 3 months, and in the beginning I noticed a great mental lift, but that did not seem as prominent over time, or maybe I just got used to a new “norm”. Sometimes I get really grumpy when I fast, sometimes not. It just sounds as if your are comparing your experience to that of others when maybe you should be paying attention to your own variations and what may lead to them. Sometimes I have a great result, sometimes not. Do you have specific symptoms that would make you think you are ill?

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