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:
- Chronic Lymphocytic Leukemia (CLL)
- Bloating, acid reflux, anxiety, depression, hypoglycemia, hypothyroidism, fatigue
- Lupus
- Depression
And here are my answers.
Chronic Lymphocytic Leukemia (CLL)
Paul,
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,
A
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?
G
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.
Lupus
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
Depression
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:
- 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.
- A ketogenic diet is both therapeutic (promotes immunity against bacterial and viral infections) and mood-improving (clears kynurenine).
- 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.
via this link:
@Lilian – To give a quick answer to a couple of your questions:
– You’ll see on the right sidebar under “Ways to Support the Blog” this statement:
“You can support the blog by making purchases at Amazon from the site. We’ll receive about 7% of Amazon orders at no expense to yourself.”
So, yes, it is beneficial to go through Paul’s site to order his book, supplements and anything else through Amazon.
– I just did the Metametrix test Paul recommends and it cost $175, including S&H to and from the lab. The test is #2105, GI Effects Microbial Ecology Profile – Stool. The reason prices aren’t listed on the lab’s site is because the tests are not available retail, only through order by a qualified practitioner. This can include folks other than MDs (my acupuncturist ordered mine).
Hope that helps.
@lillian
i’m not paul (duh) but let me answer from my own experience re:musculo-skeletal issues – make sure person is eating at least 1gram of protein per lb of bodyweight, or lean bodyweight, or desired bodyweight – and have one third of that protein come from gelatin. so either gelatin powders or bone broths, oxtails soups, chicken feet soups daily, etc. thought i find it terribly hard to measure that way 🙂
gelatin tends to be relaxing and less inflammatory than other proteins. as well as the building blocks of joints, etc.
your other ideas, msm, vit c, adequate liver & fat soluble vitamins are what i also do. you could look into chinese tonic herbs, specifically ones that have to do with joint matrix health like eucommia bark.
full spectrum metametrix stool test is around 3-400$ and totally worth it. if things show up on the first test that need to be fixed, look at doing the test again in 6-12 months. depedning on what someone’s specific issue is, the solutions will be very different – i had overgrowth of fungus/yeast/gram negative bacteria – then the 2nd time around it showed the underlying cause of gram neg. bacteria and low sIGA from leaky gut. i am progressing nicely but it wasn’t easy and have to be very strict with diet and controlling variables.
i am very interested in hearing what paul has to say about the iodoral esp. in regards to someone still having hypo symptoms after raising their t3 levels. i think the best “paleo” diet is a pro-thyroid paleo diet.
Just attempting to turn off this feed. For some reason, I can’t.
@JW
What forms of glucose did you add? She has fructose malabsorbtion issues, as do most with IBD..so its tricky?
How did you continue to heal your gut, fix leaky gut and still eat other than broths!!
haa! She also has yeast..and thyroid .
what is your diet via phd? and has it helped with your issues?
She at this point reacts to dairy, eggs,nuts, oaxalates, fructose…
so its uite challenging. The soups are good to rest the bowels, but she just lost weight and got depressed..a 4 year old depressed! so sad!!
Thanks JW
@darius
hello Darius..my 4 year old has the same..yeast overgrowth..low Siga, colitis, thyroid..
what did you eat for how long , that helped not be so low carb?
thanks Kate
@JW
I CANNOT FIND THE REPLY! from paul??
@Kate. Check this link:
http://perfecthealthdiet.com/?p=2638&cpage=1#comment-57302
Have you tried white rice? It is a good source of glucose.
Depression can be a side effect of hypothyroidism, which in turn can be exacerbated by a low carb diet. I’m sure you already know this.
As for me…it got to the stage where I was restricting so many foods I was losing weight, wasting and depressed. Certainly not improving my health. So I had to give up the idea that I could avoid every food I had a problem with, and just stick to avoiding the worst offenders, in hopes my body would over time grow stronger and healthier and digest better. After all, I wasn’t growing stronger on a severely restricted diet – it was too low in calories, nutrients and pleasure.
I am now on PHD and, yes, it has helped my issues (which include, like your daughter’s, yeast overgrowth and hypothyroidism, as well as reflux and other, miscellaneous stuff). I had been on a very low carb diet to combat yeast, but it only made my problems worse. I learned from Paul that a higher carb diet is better for yeast/fungal infection, and that has proven to be true in my experience.
Ultimately, I’m afraid it comes down to trial and error on the diet. Diagnostics, like the stool test, are useful too. I wish it were more straightforward. Good luck to you and your daughter.
i really wish there was a phd forum or something. anyway i will try to make this short. when i found out about the yeast/fungus i was still in bad shape, lots of pains, ibs symptoms all the time. slowly via self-experimentation i learned to cut out all: fermented foods, vinegars, cheeses, alcohol, dairy, nuts, seeds, and starches.
i know that i’m going to confuse the issue, and for a 4 year old person their mileage will vary, but what i learned is that for leaky gut syndrome i needed to combine phd and ray peat style advice with lots of targeted supplementation. there are a few expensive supplements that i credit for getting me out of the red zone. 1 is some kind of anti-fungal anti-yeast supplement like grapefruit seed extract, oregano oil, etc. get a few high quality ones and rotate them. a high quality probiotic like klaire therbiotic complete powder. an amp aloe extract called serovera. if i had to do it all over again those would be my foundation with other things like slippery elm bark powder, l-glutamine, etc. for a quick boost to the immune system i alos rec. xymogen igg 2000 df powder.
i do not suggest low carb, or even phd carb for a few reasons. the thyroid influences immune system health and carbs are pro-thyroid. research wilsons temperature syndrome and start collecting you and your childs temps a few times a day oover a few weeks. learn to correlate different temps with how you feel. most ppl feel better when they are warmer, 98.6 -100 degrees. like paul says the immune system needs glucose and i recommend DEXTROSE powder in bulk. not brown rice syrup, not rice. raw honey if you do good with it.
i also recommend great lakes gelatin hydrolyzed (green label) powder.it saves time on bone broth making and can easily be mixed with liquid, as can the dextrose.
liver pates, grass fed butter or ghee, and coconut oil should be staples. sunlight and vitamin d3, pastured eggs and raw egg yolks, non-bpa, non gum coconut milk is good (arroy-d tetra pak).
to summarize. kill the overgrowth of fungus/yeast/bacteria. replace good bacteria. heal lining. stop eating reactive foods. raise temp. eat pro-thyroid. keep a journal. self-experiment and change your foods as you get healthier. you may find you can drink milk again etc.
Hi Paul,
I love your book and really appreciate the information you’ve brought to us here.
What do you think of taking Betaine Hcl as a way to correct poor digestive issues?
My studies have indicated that many people stop producing adequate HcL especially as they age.
Symptoms of a lack of Hcl in the stomach include gerd, poor mineral absorbtion, (I get very bad leg cramps) and abdominal sypmtoms such as bloating and pain. I’ve had chronic IBS for many years. Constipation, spasms, and bloating are major symptoms.
I suspect SIBO (small bowel bacterial overgrowth), especially since I don’t do well with any kind of fiber. It all makes me bloated. Itis suspected that low stomach acid may allow bacterial pathogens to get past the stomach and take up residence in the small bowel.
I’ve been tested and successfully eliminated parasites, hPylori, and candida. I’ve been eating a modified GAPS diet for over 2 years. Don’t eat wheat or grains. My diet is very close to the Perfect Health Diet.
thanks for any thoughts you have on this issue.
@darius said “i recommend DEXTROSE powder in bulk. not brown rice syrup, not rice.”
i’m curious as to why you specifically do not recommend rice. just wondering…
Hi, I could not find where else to contact you for a general request so have to post it here.
Could you please take me off the list for automatic emails of new comments?
I would prefer to check Q @ A regularly to keep up rather than the constant emails which increase my data download on my phone.
Thanks very much
Kay
Hi Kay,
I’ve suspended emails to you. For future reference, you can do that yourself by going to the bottom of the page and clicking the “manage my subscriptions” link.
Best, Paul
Kay,
to change your email notifications, click on this link
http://perfecthealthdiet.com/?page_id=99999
enter your email & send,
you will then be emailed a link to manage your subscriptions.
hopefully you will able to make the change for yourself. good luck
Hi Paul;
I have a question/problem.
I have vulvar lichen sclerosus and severe migraines. I started the PHD/ketogenic diet in October for my migraines, and was happy to discover that my flare-ups of lichen stopped cold.
Unfortunately, my migraines didn’t stop, so several weeks ago, I added even more MCT oil/coconut oil to my diet and daily IF to drive my ketosis deeper.
My migraines have improved, but now I have a big flare-up of my lichen symptoms.
What gives? Do you have any thoughts or suggestions for me?
Thanks in advance!
Honeybee,
It is possible that the sclerosis is fungal in origin in which case you definitely do not want to be on a ketogenic diet.
http://perfecthealthdiet.com/?p=1742#comments
see comment to me May 11
there’s lots more on various pages about fungus and ketones
use control F on these
http://perfecthealthdiet.com/?p=4066
http://perfecthealthdiet.com/?p=269&cpage=2#comment-22709
http://perfecthealthdiet.com/?p=4066
@darius and JW
thanks for you indepth response and time.
Yes we have been doing white rice, but I think it aggravates her colitis, many of her stools are painful with blood.So yes, all those foods we are supporters of..pastured eggs, grass fed beef..real foodie stuff, except she cant do any of it without doubling over n tummy pain. So its like..”wha the heck can she eat? We are doig the broths..and just ttrying to keep it simple, but its not a variety…
Again, thanks for any and al help.
Best
one troubled mamma
@Ellen: Thanks for the links. My lichen actually was very much better for 4.5 months while on the keto diet. It flared up when I went deeper into ketosis by fasting and increasing my MCTs for my migraines.
My impression from my research is that lichen is auto-immune and it cannot be cured, only managed.
I would love for Paul to weigh in as to why my lichen got better initially on the keto diet, but my migraines didn’t. But when I got into deeper ketosis, the migraines improved but I got a lichen flare-up. It doesn’t make sense to me.
@bella
i found that dextrose digested the best & it’s more inexpensive then BRS, and les time consuming than rice for me. it’s cheap enough that people can self-experiment on their own without any hassle.
@troubled mama
have you done a GI stool test for your daughter? metametrix or another? without that it’s gonna be a lot of guess work. does bone broth cause her pain? or just “solid” foods? i might try bone broth and dextrose right now while you figure out what’s going on, at least that way she’ll be getting fat, protein(gelatine), and glucose. add in some raw pastured egg yolks and some liver/ghee pate once a week and it sounds solid as a temporary solution (maybe. i’m trying not to overstep my bounds here). as i said b4 it’s a kid so things are different physiologically. if you were only going with one supplement perhaps the serovera aloe product as it has lots of great testimonials for IBS/IBD issues.
i can’t stress enough getting some basic stool testing done to at least eliminate some guess work (unless you have gotten it done, and now you have to decipher what it means), then u can go from there with targeted probiotics, etc.
@Ellen: From reading your links, it sounds like you’re talking about lichen planus. I have lichen sclerosus — it’s a totally different disease.
Honeybee:
I was just guessing that there *might* be a fungal connection, based on Wiki saying that lichen sclerosis is of unknown origin. My thinking came out of the way Paul suggests using diet diagnostically for things like this for which there is no conventional testing.
The name of the disease really doesn’t matter if it is only a descriptive and not based on understanding of cause or how to cure it. They apparently don’t know the cause of the other disease you mentioned either. The skin doctor gave me yet another name for my rash, but also was honest enough to admit, they didn’t know the cause of that one and they had no real long term cure.
As I understand what Paul has said, anytime ketosis causes a skin ailment to flare, that indicates the ailment is fungal….
My guess is that the initial diet was not all that ketogenic for you and that allowed the coconut oil beneficial. But that the strong ketosis on the second diet overcame the antifungal action of the coconut oil and actually fed the fungus.
So while we are waiting for Paul, I am curious to know if
you were you having any coconut oil in your diet on a regular basis before your initial lower keto diet, the one that did stop the lichen?
Ellen
have you checked out Robyn O’Brien? http://www.youtube.com/watch?v=rixyrCNVVGA
I’ve been having this discussion about food allergies and disease with people for a few years now. basically i question whether people are allergic to foods or allergic to the industrialization of foods. things like hormones, genetically modified, pesticides. when i grew up in the 1970s i can’t remember any kids with food allergies.
i read most wheat is GM is the US, something about potatoes being GM to contain a pesticide. i already knew the US had high rates of chronic disease. i already knew the food had changed dramatically in just my lifetime.
seeing this talk by Robyn O’Brien puts a lot of what i already knew or suspected in place.
i think the whole country should put more emphasis on the industrialzation of food rather then the food itself. my grandpa never ate the wheat, soy, milk, or corn that i’m eating.
@darius
Yes..we had one stool done by doctors data 6 months ago..showed candida and rhotodurula yeasts.+3
We just did another 3 weeks ago with metametrix..should be back any day. Both paul and chris kresser suggested to get another one..so its possible she has other pathogens not detected in the doctors data. she had thrush at 7 months..(candida) and then at 12 months started reacting to foods, and not able to absorb anything..Then she contracted some weird virus, they didnt know what it was at the time..rotovirus..after that by 18 months she started getting sick ..alot..pnuemonia.
.We didnt know if she had cystic fybrosis or celiac..then we tested for everything..negative. Then I just removed gluten and dairy and she improved..she started having rectal prolapse at age 20 months..this went on for a bit..then stopped and she grew and was healthy other than swollen tonsils..(which was still some food allergy we didnt know)
Then she got brohncitis, and then came the final blow..2 more doses of hardcore antibiotics..man if i could turn back time..then it all went to hell..her prolapse came back..she started becoming or showing sides on the autistic spectrum..loosing weight, “shrinking” wetting the bed, and a hug excema patch appeared on her leg, and she started getting rashes everytime she ate anything.
tHEN we founds GAPS..started intro for a week..she lost 2 pounds, and looked liked she was going to die..yellow skin tone..we got her blood work done, and it showed her T3 AT 3.3..LOW AND TSH 5.45 HIGH.
So her thyroid was beginning to be effected by gut dysbiosis and low carb. at this point she still has leaky gut, her neck lymphs are swollen, still has slight yellow color(back up of bile,c ongested liver). Yes she can handle broths..but is soooo sick of eating them. Now anytime she has honey or fruit she reacts..so its FODMAPS, and hse is Oaxalate sensitive..will urinate and her uric acid levels in blood work were high..
But ist like,,she needs carbs, yet safe carbs,,she needs glucose, fructose that she doesnt react to, protein, ..supplements…i wish there was a magic person ..maybe Oprah that could come adn like find us person who knows what to do!
So now I am just like…WHAT THE @#$%$#!! do i feed this kid!!! Oh yeah…and ocasiionally there is blood in her stool. Pediatric GIS’s are retarded,,,they know nothing of nutrition…want to put her under and scope her, take biopsie(which bleed for days after ) and endoscopy. I am assuming she has a serious yeast ..Sibo, and showing definate signs of colitis..Chronhs with the bleeding. Her white and red bloos celss were right on..so thank god her system hasnt let the cancer cells out yet,,,
anyway..
uggg.
i am so lost and dont know what to do anymore….
Hi Dr. Jaminet,
My 2 yr. old, 4 yr. old, and I have been loosely following The Specific Carbohydrate Diet by Elaine Gottschall off and on for nearly 1 1/2 years; for about half of that time we were “fanatical,” as the diet calls for. No starches, even in our medication. Not getting the results I’d desired and running into complications, I’ve been looking for better (i.e. less restrictive) options.
In the beginning, my 4 y.o. had frequent stomach aches and pale, floating stools; my 2 y.o. had constant diarrhea; I had gas and bloating. Because we went gluten-free first, we could not test for Celiac’s, but both children carry the gene, though they are low-risk. Without grains and starches, our symptoms greatly improved.
However, I ran into a short case of hives, after taking anti-fungals. Then, I had a miscarriage at 6 weeks. And, now, I have a small uterine fibroid, small dermoid cyst on my right ovary, and I small lipoma on my left shoulder head. I feel that the SCD, low-carb diet may have thrown my system off.
We have reintroduced sweet potatoes with some regularity and recently tried rice. However, my 4 y.o. had a distinctly GREEN bowel movement the day after trying rice and my 2 y.o. woke twice in the night after rice for dinner. And my bowel movements have changed, becoming thinner and broken, when they were nearly “perfect” after doing a colon cleanse.
How do you recommend approaching gut dysbiosis? Should I follow SCD’s guidelines and avoid starch, despite out bodies need for glucose? Are bananas enough (very popular on SCD)?
Thank you for your help, in advance.
@Ellen + @Honeybee
Ellen said: “As I understand what Paul has said, anytime ketosis causes a skin ailment to flare, that indicates the ailment is fungal….”
Just to expand on that a bit, I believe Paul says that ketones can be utilized as fuel by any eukaryotic pathogen. This would include not just fungi but parasites, protozoa and perhaps others.
@Kate-
Holy smokes, I feel for you and your little girl. Perhaps a progressive infectious disease specialist could do a thorough workup? You might have to travel to see one.
Not to oversimplify the condition, but have you tried anti-fungal treatments recently, since you’ve identified that yeast is at least one of the problems?
@Ellen:
Thanks for your insight about the coconut oil; that, indeed, may be a clue.
I did have coconut oil in my diet before starting keto in October, but added more when I decided to try keto for my migraines. Since October, I have been spot-checking my urine with keto-stix, and had been spilling trace ketones. Since ramping up my ketosis with fasting and more MCTs, I have been in the +1-+3 range.
I’m between a rock and a hard place. My head and general mood feel much better on ketones, but the lichen is pretty nasty.
“peas […] are fine”: elaborate.
@ Honeybee:
Yes, you are indeed between a rock and a hard place.. But at least, if it is fungal, there is a possibility of actually curing the lichen by treating the fungus aggressively. And then perhaps it would be safe to do a ketogenic diet…
As to what Bella said about protozoa, parasites etc. also being fed by ketones, that is true, he did say that. But I am not sure that they show up on the skin…maybe they do. I don’t know….
One other thing to look into would be biofilms. I know that fungus forms biofilms with other stuff. So, if it is fungus, you will most likely need to deal with biofilms too to really get at it. If it is protozoa etc. I don’t know if they form biofilms.
@Ellen:
Thanks for the suggestions. I will keep them in mind and do some more research. After all, I don’t have anything to lose!
To tell you the truth, it all seems pretty overwhelming to me. I’m not really convinced that lichen sclerosus may be caused by fungi or protozoa, though. If that were the case, why didn’t my dermatologist who diagnosed the lichen by biopsy have recommended a medication for it? All she offered me was steroid creams, which I refused. I have never seen any medical evidence suggesting that lichen sclerosus can be cured, but would welcome any treatment suggestion!
I am a total dufus, though, because after thinking about what you had written before, I realized that one big change I did make when ramping up keto diet with IF, was that I added having one cup of coconut milk every morning to get me through to lunch without eating. Duh!
I’m going to lay off of that and quit the IF for a bit, while trying to stay keto enough to keep the migraines and lichen symptoms at bay.
Still hope that Paul will have a chance to give some advice, but I know he’s a busy guy. In any event, thanks a million for weighing in and giving me a jumping off place to think more carefully about this; I really appreciate it!
@honeybee & @Ellen
I’m very interested in this conversation as well, Ellen you give some food for thought for sure. It seems to me (logically) that with a biopsy they would know if this was a fungus or whatever. It would be great to be able to understand how this works.
My own LS symptoms improved tremendously when I started low carbing. I wasn’t diagnosed officially yet at that time. I couldnt tell you if I was in ketosis or not as I was never hard core about it, just did my best to (at most times) avoid starchy carbohydrates and eat real food. I was diagnosed when I had an incredible flare up. Since I wasn’t really paying attention to the connection between LS symptoms and diet at the time, I can’t tell you if the big flare up happened during a “cheat.”
I get flare ups occasionally which are very painful (and for which I use the super potent steroid cream for). My symtoms are most definitely related to my cycle which also improves if I manage to stay clean with the diet.
I have since developed a second, more serious, auto immune condition and I’m doing my best to eat ‘clean’. I have added safe starches, I’m working towards figuring out how to heal my gut. (When I mentioned ‘leaky gut’ to my doctor, I got a ‘there’s no such thing…be careful about what you read’.)
Figuring this out while you are busy trying to cope with illness and life is a bit overwhelming. I sure appreciate reading all the insights/information here!
Paul, wherever you are, your presence is sorely missed. I’m sending good thoughts your way.
Honeybee & LM
Yes, you would think that a biopsy would reveal all. Perhaps there are only certain strains of fungus and/or other beasties that they test for? So others just slip by?
I hope Paul can enlighten us.
Certainly, if LS is a fungus, there is a sweet spot between low carb and ketosis that would be best and that may be very individual depending on your glucose regulation and probably a bunch of other things.
I know that for me my foot fungus improved dramatically years ago when I cut way back on carbs…I didn’t make the connection till a while after it happened. Blood sugar wasn’t on my radar then.
I am sure that in some people their menstrual cycle affects blood sugar…that was years ago for me, but it certainly felt like it it did. I would think that it would be helpful to make sure blood sugar and adrenals are rock solid. That can only help.
Kate
Hello, I’ve been following your posts and sympathising with your predicament, I can hardly imagine how difficult it must be to have such a small child with these health problems. It’s bad enough when it’s an adult.
Please bear with me if you’ve already addressed these points elsewhere, it’s a bit time-consuming to go back over the entire history.
1. Is there a reason for not trying dextrose? I’m wary of it for myself because corn makes me feel dreadful and it’s SCD/GAPS prohibited because of the chance that it isn’t pure. If your daughter has a problem with corn, you might consider trying an organic tapioca-derived dextrose available in the US, here’s the link:
http://www.naturesflavors.com/index.php/organic-dextrose-powder-kosher-vegan-gluten-free.html
In reply to someone else’s question about why white rice/rice syrup may be problematic – this applies if the problem is with di- and polysaccharides as opposed to a problem with toxins/allergens. In this case, only monosaccharides can be tolerated ie glucose and fructose and if there’s a problem with fructose then dextrose powder is the obvious thing to try.
2. Have you done the full GAPS diet as opposed to GAPS intro? If not, maybe you could try it with adjustments made for your daughter’s needs as it’s less restrictive.
I read a post elsewhere about why it is that GAPS can cause problems. Apart from the PHD answer re insufficient glucose, there is also the variability of what people mean when they say they are following GAPS eg are they making the 24 hr yoghurt? eating too much fruit or honey or nuts? excluding fruit because of candida? unwittingly eating trace amounts of gluten or starch?
If the SCD/GAPS premise is correct, that healing and sealing the gut will precipitate healing of other conditions, then it would seem important to prioritise that whilst maintaining enough nutrition to allow the healing to happen. It’s not enough to remove offending foods, in fact this will make things worse if basic nutrition is compromised and debility ensues.
It must be abslutely dreadful to not know what foods to give your daughter and, again, I completely sympathise. It may be the case that certain symptoms are unavoidable in the short to medium term whilst you pursue the goal of healing the gut first.
I would suggest being very cautious with introducing supplements, doing them one at a time in v small amounts to start with. Some seem to work brilliantly for many people but some of them can be problematic eg l-glutamine, aloe vera, slippery elm (v starchy).
If you are looking for a probiotic and BioKult isn’t well-tolerated, you may consider Ecodophilus by BioNutri – it doesn’t contain FOS, and introduce it v gradually as per GAPS.
If your daughter doesn’t tolerate the bone broth (have you tried it with all fat removed, leaving just jelly) then how about meat stock with very well-cooked meat.
Are you using ghee from pastured cows eg Pukka? There is also X-Factor Gold High Vitamin Oil. Over time, these should help to heal the gut.
I wish you the very best in your efforts to heal your daughter.
Thank You Frances for such an in depth response and your kind words. It is very challenging. Again thanks for taking such time and thought to our situation..its so much more heartbreaking when its a little kid!
We started with full GAPS, but she was reacting to so many things it was clear we needed to heal the gut firts. But when we did, she just lost more weight and her thyroid got wacky. We use CUSTOM PROBIOTICS six strain..they actually have helped clear her excema patch on her leg.
I ordered some dextrose and will try that, and the tapioca..any suggestions on recipes? Can you add dextrose, tapioca to water? this might help alot better than rice, because she is much more constipated. I was juicing for her, apples, carrots, but then we realized she was oaxalte sensitive and fructose sensitive(issues with many with IBD) I think your right..darius, and devi too..just keep eating, and try to avoid the most horrid offenders..(nuts, dairy, eggs, most fruits,oaxalate veggies).
We will keep you posted..in hopes that our situation can maybe help someone else.
Best,
Kate
Hi,
I just found this website, and am finding some great information!
My wife, myself, and our 4 children all started GAPS 3 weeks ago. My wife and at least 2 of the children have Candida, and all have digestive issues. So far, the kids are doing great! The kids can’t believe how wonderful they feel, and my wife is noticing more progress than when she was ona candida diet.
I, however, am not doing as well. My muscles ache to the extreme, I feel light headed most of the time, and am quite tired. I love soup, but these past couple weeks the broth makes me nauseated, as does most food. I lost 15 pounds in the first week and 4 pounds the second. Now I seem to be stable. I was originally overweight at 248 pounds, and my ideal weight would be about 200.
I hope someone hear can give me some advice.
Thanks!
Hi Paul
I hope this finds you well. A few questions to add to the many. 🙂
I have been PHD compliant for a while. Taking the supplements as well, including 1/4 t daily of epsom salts. I have psoriasis on certain places in scalp. I use Neutrogena T-Gel shampoo 2 times a week to manage it. Recently I have notice a lot of hair is coming out when I wash it and it is noticeably thinner. I am wondering if the shampoo is too harsh? Could it be from yeast problems? (I am treating fungus in toenails.) Should I reduce epsom salts?
On another note, I read on the site that kelp was not recommended for idodine supplements? Could you give the reason and suggest a good one?
Another question. Would you have any advice for my dad who has lost 25 pounds in the last year? He can’t gain weight. He is a skeleton now. He too is on the PHD. We can’t figure it out.
For Andrew who posted on Februray 17, with the blood pressure fluctuations. Do you need a tilt table test? Could it be neurocardiogenic syncope? I have that.
Many thanks!!! Helena
@Jeff – are you on GAPS Intro or full GAPS?
I did “anti-Candida” GAPS for 6 months last year, including a month of hard core Intro, until the glucose deficiency symptoms got so bad I began to look around for alternatives. Then I found PHD and improved when I began eating starch. As you might imagine, my advice is to keep safe starches in your diet – white rice, potato, sweet potato, taro, tapioca, etc. This is especially true if you don’t have any type of bowel disease.
(The first non-GAPS food Dr. NCM recommends introducing after “finishing” the GAPS diet is new potato, so it’s not too far afield.)
You could experiment by adding starches back for a few days and noting if your symptoms improve. At least then you’ll have information about what’s causing you to feel bad.
Good luck!
“peas […] are fine”: Please elaborate.
anon,
do your have a link to your reference of “peas […] are fine”.
i cannot find it
Hi Paul,
A friend recommended your site. I appreciate the information you provide. I’ve ordered your book and look forward to reading it soon. I eat 80% paleo and am pretty healthy and fit but I have a nagging problem I don’t have a handle on.
On most afternoons I get so tired that I just about have to take a 20 or 30 minute nap. I work from home so that’s not a big deal. I’m more likely to need a nap if I’ve eaten more than a small amount of fat late morning or early afternoon. If I consume fat at night, it’s not a problem. I started having this problem 3 years ago when I did a zero carb diet for six months. Sometimes, if I add sea salt to my food then I can tolerate more fat. I’m wondering if the problem is with my adrenals, or my liver, or what? I don’t eat much fruit or much grain. The problem is certainly not a sugar crash after lunch since most days the only carb I eat is cruciferous veggies.
Thanks.
SL in NM
Dear Paul,
First off, thank you very much for your wonderful website and book, and all the fantastic information that you share.
I have had scleroderma for 11 years, and although I am not a scientist, I have done enough research to appreciate what a kindness you are doing by synthesizing the massive amounts of data available into something that a “layman” can understand.
My question is as follows: a few years back I stumbled across the Marshall Protocol, and his recommendation to someone on the Protocol to limit Vitamin D foods, folic acid supplements, etc. I could not start his protocol because of the potential side effects, but just as an experiment I eliminated the Vit D foods from my diet. I noticed a very dramatic decrease in pain as soon as I did this.
About three years ago, at the beginning of a pregnancy, I felt irresponsible not taking folic acid! So I began supplementation; with the immediate effect of a substantial increase in pain — I had to stop after one day (the baby was fine)! I am ok in the sun, but egg yolks, fish, etc, are actually debilitating for me.
I wonder what your thoughts are regarding this and starting the PHD — I am seriously contemplating giving this diet a go for my condition, even though it would be hard for me (specifically because so many foods would not be available). However I am certain it would do me a world of good!
Thank you again!
Leah
Bella,
We are almost at the end of the intro.
I think I will look more intothe starches – thanks!
Hello Kate
I don’t know anything much about tapioca (my suggestion was for organic dextrose derived from tapioca in the hope that it will be pure and free form starch). As tapioca is starch it is on the GAPS avoid list. But if you want to try it I imagine that there must be recipes online.
Have you had the opportunity to consult with a Paleo-friendly or GAPS practitioner? There must be other children, just as there appear to be many adults, who do not thrive for long on GAPS/low carb but who cannot tolerate starch.
My next suggestion is a bit off-the-wall – there’s been quite a lot of stuff lately about unwell people using human breast milk as an aid to healing. There are websites where nursing mothers who produce excess milk for their babies are selling it. I imagine that there may be issues around screening the milk, I don’t know much about it, but it might be something at least to consider if you’re really desperate.
I hope that idea wasn’t too disconcerting!
Anon2: Here’s the link to the PHD page where “peas are fine”
http://perfecthealthdiet.com/?page_id=8
Hi Paul,
I was wondering how you would recommend spacing meals for someone who is rather active throughout the day, not from glycolytic activity but just everyday stuff (i.e. walks about 5-6 miles a day and has a pretty active job). I tend to need about 3.5k-4k calories a day or else I get really fatigued, only problem is I find it hard to stomach more than about 1-1.2k calories or so per meal–my stomach gets full. I also would like to practice IF, but don’t know how to go about getting all the calories I need in an 8 hour window. Any help in the matter would be greatly appreciated. Thanks again, Paul!
Thanks Connie,
i was trying to help ‘anonymous’ & ‘anon’ with their questions
….“peas […] are fine”: elaborate.
&
….“peas […] are fine”: Please elaborate.
i was able to find quite a few references myself, so i was unsure what information they/he/she were after?
Hi there:
I would so love it if you could make your book available in libraries. Any thoughts on that?
Do you think a ketogenic diet would help w/ dystonia that is generalized? Mine seems to relate to a head trauma that dislocated my jaw when I was 17 (now 52) and was never repaired correctly. There is no tremor associated with it; just an incredibly hyperactive situation that is rapidly destroying my spine tendons and joints (and sanity?). There is also a failed neck surgery (3 of them so now c3 cantilevered over c4 (kyphosis).
I have been predominantly paleo for 8 months and completely wheat free for longer. Also using coconut oil in cooking. There does not seem to be any improvement.
Hello
Just got a diagnosis of ulcerative colitis and I feel a bit overwhelmed with information. I was told it is an auto-immune disease so I don’t quite understand why this disease often responds to a change (improvement) in gut bacteria. I was diagnosed with another auto-immune disease (lichen schlerosus) several years ago.
I’ve spent hours reading your site and I honestly don’t know where to start. I’d like to start with the fecal transplant route but I haven’t had my post diagnosis app’t the gastroenterologist yet to find out if it’s something that’s done here in Canada. Somehow I doubt it.
Which areas of your book should I concentrate on? I’ve been trying to read it for weeks but I’m not getting very far. I used to love to read but for the last couple of years I seem to have problems staying awake and keeping everything I read, straight. Now that I’ve read quite a bit on this site, I’m thinking I might be in bigger trouble than I realize.
I’ve been in a flare up for eight months (yes, amazing that I didn’t get my colonoscopy/diagnosis earlier, our healthcare system has many flaws along with the good points). I’ve been symptomatic (bleeding) every day of the eight months, but no pain until I actually had the colonoscopy.
Since I didn’t know what I had, I decided to just eat real food for the most part. I was low carb-ish until I found this site. I avoid grains now, but up until a couple of months ago, I would have a slice of toast now and then. I’ve added rice and I feel better mood wise, but I’m so hungry now. I’m running for the bathroom about about 15 minutes after I drink kefir or raw milk.
Anyhow, I I’m aware I have to experiment with different foods but it seems pretty universal that one needs to avoid insoluble fibre. I’m not sure about avoiding eggs, and nightshades because of the auto-immune aspect. I think I should make the bone broths a staple and I’m wondering if it matters that I prepare them using veggies like celery and leeks which I will strain out?
Thank you so much for your generosity with this site I am amazed at what you are doing. If you can offer some guidance/direction I will be even more grateful.
Hello Paul,
I followed your recommendation of eating more carbs on rest days (100-150g) and also started supplementing with Iodine (600mcg/day). My carb intake on Workout days was approximately 300g. Here are my latest lipids:
TC: 374
HDL: 69
TG: 86
LDL: 259 (Iranian)
Things seem to be staying the same or even getting worse. How long would you expect it to take for the numbers to show at least some improvement if carbohydrate deficiency or Iodine deficiency is involved?
The best numbers I ever had were these:
TC: 280
HDL: 81
TG: 60
LDL: 155 (Iranian)
This was back in October 2011 when I was cooking my food with olive oil and limiting coconut oil consumption to maybe a couple of tablespoons per day (making omelettes). Now, I cook in coconut oil and don’t have any olive oil.
The other major difference in my diet at that time was that I wasn’t cycling calories/carbs or doing IF. Carb intake was around 100-150g per day regardless of working out. Now, the extra carbs I eat come mainly from bananas and some honey, alongwith potatoes and milk which I had last year too.
Since the last couple of weeks, I am eating around 2800 calories on rest days and about 3350 on workout days to try and build some muscle. This means I’m eating a lot of fat and protein for the bulk of my calories, combined with PHD level carbs on rest days and double that on workout days. I am very lean at the moment; 157 lbs at 6 feet 0.5 inches and ~8% bodyfat.
Other things I’m noticing now which weren’t apparent last year are a constantly runny nose, foul smelling gas and inconsistent bowel movements (vary from ok to slightly constipated to slightly loose).
Major changes I’m looking to make:
1) Start cooking with olive oil again while limiting coconut oil to 1-2 tbsp/day
2) Reducing honey and banana intake
3) Decreasing the level of carb cycling, i.e. having maybe 200-250g instead of 300g+ on workout days
4) Stopping extra vitamin D supplementation. Going to stick to just the 1600 IUs I get from my multi
5) Going back to the phytosterol containing multi I used to have last year (I know, I’m desperate to get the LDL down)
Do you believe that I could have FH? I don’t think a test is available here for it. Having gotten down to a TC of 280 with TC/HDL ratio of < 3.5, I thought that pretty much ruled out FH. Now, I'm considering the possibility in addition to thyroid issues, iodine deficiency, etc.
I'm really perplexed about the reaction of my lipids to increased carb consumption. The more carbs I eat, the worse my TC/HDL ratio gets. I wonder whether the amount of carbs alone is the problem or combining them with a large fat intake is.
I posted my free T3 and free Test levels before but here they are again:
Free T3: 1.96pg/ml
Free Testosterone: 16.5pg/ml
Any help from Paul or anyone else in the same boat as me would be greatly appreciated. I am worried sick.
Regards,
Jarri
Hi Paul,
Thanks for your time in responding to reader queries. I love the book – but am on about my third read through – very detailed, and takes a couple of reads to get my head around it all.
I am hoping you can assist with some queries for me. I am recovering from burnout (and feeling a lot better – the depression has gone), but still have periods of being stressed easily and feeling apathetic, and have strong sugar cravings. The sugar cravings seem to be under control when following PHD guidelines (but can’t even have a little bit of sugar – still early days).
My query relates to a combination of losing some weight and leaning out (around 10lb) and getting the body healthy again. I am also still suffering from bleeding gums, cold hands and feet, I haven’t had a menstrual cycle in nearly 12 months and still get stressed easily,
To start the weight loss, I have been following the guidelines from the book and in Jay’s article on weight loss, including 8 hour eating window, coconut oil and 1-2 meals a day and working on the basis of a calorie deficit. However, given the burnout issues, I was wondering if this will assist with helping the body recover given most articles I have read re recovery from burnout talk about eating every 3-4 hours, which can be a hassle.
Would be interested to know your thoughts so I can structure my approach to PHD for my current position, and looking forward to a healthier body!
Thanks again
Caroline
@HM,
Paul usually says that impaired cognitive function (like not being able to concentrate) is down to a brain infection or circulating toxins. Theres a brain infection post http://perfecthealthdiet.com/?p=134 that you could look at. For the toxins Paul usually recommends charcoal or bentonite clay (I take 4 Braggs charcoal tablets a day, in the morning – you cant take them with food or supplaments as they can absorb nutrients and you cant take too make as they can absorb too much bile but I dont know how many would be too many)
Theres also a healing from bowel disease post http://perfecthealthdiet.com/?p=258 – most of the supplaments are the same so you might find that what helps one helps the other.
As I understand it, which might not be quite right in fairness, healthy gut bacteria protect your gut and keep it healthy so that might be why people respond to probiotics. Either way if they help I would take them.
Hope this helps and wasn’t teaching you to suck eggs 🙂 Sorry about all the typos, my brain fog is shocking today!
Hi PHD community.
Has anyone out there gone down the route of getting their carbs from dextrose? I’m interested to find out if there were any initial symptoms that occurred and if there was an adjustment period while your body got used to having carbs again.
I personally have ulcerative colitis and possible candida issues and am going to start with dextrose as it will hopefully allow me to have the carbs without the fibre of the safe starches.
Thanks for reading.
Mike
Hi Paul,
I think I am one of the few who does not seem to be experiencing benefits of following this way of eating and my frustration level is growing. I thought I would share my expericence and see if you have any thoughts on how to proceed.
I had been overweight most of my life and then about 12 years ago lost 55 lbs and was healthy and kept it off for about 9 years. Then, all of a sudden I gained 7-8 pounds , which turned into 15 which turned into 30. All the while keeping up with the exercising I ahd started when I first lost the weight. I also found out at this point that I had high cholesterol, high blood pressure and while not diabetic, my blood sugars were elevated. My TSH was also at 3.9. I did some reading that suggested anything over 3.0 is generally hypothyroid. So I increased my exercise 25% a week and decided perhpas I should seek help from an endocrinologist for my thyroid. By the time she did my test, my thyroid was up to 4.5 but she wasn’t concerned about my thyroid but put me on Metformin for the elevated sugar and told me I had metabolic syndrome. I then met with a nutritionist – some of what she said was expected, but she did talk about cutting way back on carbs and fruits. This got me into some further research and I came across your Perfect Health Diet book. I admit a food weakness for me is pasta, so after I read this book ( and I also read Wheat Belly byt Dr. Davis) I thought it sounded like the healthiest approach for me. So… I change my exercise to just walking, completely revamp the way I eat. Threw bags of processed food out of my cupboards, stopped eating corn and have not eaten anything out of a can since Jan 2 because I am buying everything fresh, started getting my meat from a local farmer’s market who carries only local pastured products, besides not eating flour at all I cut down on other grains and fruits so I am eating less sugar and carbs overall ( eating about 100 grams of carbs a day comprised of some veggies, a little fruit and white rice compared to about 300+ I was eating before) , I bought erythritol and almond flour so I wouldn’t be tempted to cheat, I am buying pastured eggs and butter, and I started taking all of the supplements recommended in the book. I have been following this since January 2 and have only lost about five punds but I kept thinking the weight didn’t matter, because it would be makng me healthier. Then I had blood work about a week ago, my results are worse than they were – my lipds are up, my blood sugar is up and my liver enzymes are elevated. Any suggestions on what could be the culprit or what might help?
Thank you so much,
Courtney
Hi Courtney,
First, losing 5 pounds in a month and a half is not bad. You’re right to focus on health issues. It can be dangerous to try to lose weight too rapidly if you are hypothyroid or have other illnesses.
You need to tell me the numbers to tell whether lipids are a concern. Blood sugar I presume is a fasting blood glucose? Lowering carbs often raises fasting blood glucose. The thing to do is to get a blood glucose monitor and measure your blood glucose yourself in order to see how it responds to meals, get multiple data points for fasting glucose, and see how dietary changes affect these.
I’m going to guess that your fasting blood glucose has elevated from the carb reduction, and that you are eating too few carbs, perhaps in part because you are counting carbs from veggies which you shouldn’t. I think the best thing to do is get a blood glucose monitor and try adding more carbs until you find a mix that keeps both fasting and postprandial blood glucose. You want to be below 140-145 mg/dl at all times.
Liver enzymes are a concern and suggest a nutritional deficiency. Make sure you eat 3 eggs a day plus 1/4 lb beef liver per week; that should help.
Cut oils and fats on meats to make up for the calories from the extra carbs, eggs, and liver.
Otherwise, it sounds like you’re doing great. I agree with just walking until you get your hypothyroidism under control. I think a TSH of 4.5 generally calls for treatment, definitely if you have any symptoms. Make sure you take selenium and low-dose iodine, and ask your doctor to prescribe a minimal dose of levothyroxine to see if that makes you feel better.
Best, Paul