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. I’ve had acne since I was a teenager, and experimented with various things (including low fat) which were more or less disasters. Eventually I tried the PHD which seemed to work better but I found that certain foods still caused problems, including any amount of fruit and potatoes. I experimented with a 4-5 day fast which was pretty effective although rather stressful. I decided to try taking some antifungals, including olive leaf, to see what happened. This resulted in pretty substantial headaches and brain fog, but my acne did improve. After a few months of this (I’m stubborn) I finally got tired of things and decided to quit the antifungals. My face is looking better than ever, almost clean really, but the headaches have continued. I have a moderate headache with brain fog pretty much continuously, and ingesting any sugar and I mean even the tiniest amounts, like eating sausage or bacon or salad with balsamic vinegar will really make things worse, which will usually be semi-correlated with a zit or two although I haven’t written anything down. I’m getting a bit frustrated with this because although acne is annoying and obnoxious, not being able to concentrate for my job (which includes a good bit of computer programming) is far worse. I tried the NAC test for CPN infection but didn’t get any symptoms. Physically I feel great really, I just can’t think straight.

    I did go to the doctor and received the usual silliness about how these things are all in my head etc etc.

    Hi Anthony,

    Sounds like you did have a fungal infection and now you have residual circulating fungal toxins (eg fungal cell wall components). These can circulate almost indefinitely, they get excreted by the liver through the bile and then get re-absorbed with the bile in the gut.

    The solution is simple. Use detox aids like bentonite clay, activated charcoal, or cholestyramine to bind the bile & toxins and excrete them in feces. You can support that process with bile supports like vitamin C, taurine, and cholesterol and liver supports like glutathione or NAC.

    Best, Paul

  2. re: mike + dextrose

    i found that starches increased constipation and fatigue for me, switched to dextrose, immediate relief while still dealing with other aspects of my health like healing my gut lining and increasing my sIGA. i had “candida” before, more specifically came back as high fungal and/or yeast in a full stool test. stool tests will never say “candida” as it really makes no sense as a person may potentially have a candida overgrowth and/or any other overgrowth or disproportion of any number of yeasts, fungii, and bacteria.

    i think any adjustment period someone might have with dextrose is just feeling a sugar rush because it digests faster, you can easily tweak this by adding fats and/or protein to a dextrose drink. some examples would be gelatin (hydrolyzed or non), coconut milk, or liquid dairy if you tolerate it well.

    perhaps in some cases someone might have reactions to the fact that dextrose is made from corn, and possibly made from GMO corn. i haven’t tried it but there is a tapioca based dextrose powder available on the internet.

    as for your UC issue i would suggest researching serovera, an AMP aloe extract that seemed to immediately diminish my IBS symptoms.

    hope this helps

  3. @Rosemary: I first read the PHD book courtesy of my local library. I would talk to your librarian about requesting a book. To the best of my knowledge, authors have nothing to do with which libraries carry their books. Books are purchased at the discretion of the library.

  4. @Carole

    Thanks! That’s really helpful information. I missed the bowel disease link you supplied somehow.

    I’m so appreciative that you took the time to help me out. That was great!

  5. @darius

    Thanks for the great advice. I tried white rice a few months back and probably didn’t give it long enough to be properly sure but am currently getting over a big flare and on steriods so thought best to start with the easiest to digest.

    I managed to get up to 30g dextrose today (aim is 55g for 200 carb calories). Its not easy getting that much in every day. How did you manage it?

    I did feel odd today but I haven’t had any significant carbs in my diet (aside from veg and berries) for about 3 years so that could account for it! I definitely felt wired but also my heartburn was a lot worse. A bit concerned that it could be feeding the yeasts but i’ll give it until the end of the week and hope these initial symptoms subside.

    Thanks for the Serovera tip. I’ll definitely look into that.


  6. @ mike
    here’s my line of thinking: thyroid and immune system are linked, thyroid is king of hormonal regulators (again, my current opinion).
    optimal thyroid = optimal digestion and body temp and immune function. if dealing with uc or other autoimmune like issues then the immune system is cold/weak/confused/lacks resources and needs support. what supports immune system? glucose. what supports thyroid? sugar/carbs/glucose.
    paul recommends 150grams glucose a day, thats 600 calories. being hypocaloric or undernourished in any way, micro or macronutrients, is a stress on the body. stress uses up glucose. if not enough glucose then stress (including the stress of uc/autoimmunity etc) causes backup functions to turn on like cortisol and adrenaline (corticosteroids). in the short term these are useful to give you extra energy and pain relief so that you can stop the negative cascade. SHORT TERM.
    so all stresses need carbs. thyroid needs carbs. immune system needs carbs. immune system needs good thyroid. good thyroid needs less stress.

    finally, i know i am oversimplifying but… does creating glucose from protein create an unnecessary and possibly extra stress on the body’s resources when the system already is in a danger zone from gut and autoimmune issues?

    for everyone reading this, please isolate variables and test out different forms of carbs and different mixtures, timings, and preparation styles. some may do better with starches but only in the morning, or only in the evening, or only after exercise, or only with a lot of protein, or only with a lot of fat, or neither, or both… get it?!

    back to mark, find a way to shut down the uc symptoms immediately so you can get more carbs (resources) to where they are needed! thats why i suggested serovera. we have to weigh cost/benefit and short and long term strategies. get your body the resources it needs to do the job(s) it needs/wants to do.

  7. Great post Darius – a good summary. Thanks

  8. i just want to reiterate that i am still learning:
    1) i am not sure at which point genetics or hidden infections that paul talks about will effect everything else
    2)i am not sure about macronutrient ratios and total optimal daily/weekly caloric needs
    (for instance i was just listening to paul’s paleo summit interview and a 3000 calorie diet with paul’s optimal %’s would be 200 grams fat, 225 grams carbs, and 113 grams protein. the reason i’m not sure on this is that genrally people recommend at least 1 gram of protein per # of lean bodyweight, or more, especially if athletic. and i do believe athleticism is part of being human. i weigh 185 lbs, this 3k cal diet wouldnt give me enough protein, but it would give me excess calories… y’know? i’m also not sold on if a higher carb or a ketogenic diet is optimal, and what situations would each of them be useful.)

    anyway, asides aside, i personally am going to start taking more vital measurements throughout the day: blood glucose, temps, urine brix, body fat calipers, finger pulse rate. and try and save up $ for more blood tests from directlabs.com

    it’s tough to gain “definitive” conclusions without a big picture view and lots of data trends and record keeping.

  9. Re:
    “peas […] are fine”: Please elaborate.


    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?


    “# Do not eat calorie-rich legumes. Peas and green beans are fine. Soy and peanuts should be absolutely excluded. Beans might be acceptable with suitable preparation, but we recommend avoiding them.”



    “# Do not eat toxic foods. Notably:

    * Do not eat cereal grains — wheat, barley, oats, corn — or foods made from them — bread, pasta, breakfast cereals, oatmeal. The exception is white rice, which we count among our “safe starches.” Rice noodles, rice crackers, and the like are fine.
    * Do not eat calorie-rich legumes. Peas and green beans are fine. Soy and peanuts should be absolutely excluded. Beans might be acceptable with suitable preparation, but we recommend avoiding them.
    * Do not eat foods with added sugar or high-fructose corn syrup. Do not drink anything that contains sugar: healthy drinks are water, tea, and coffee.
    * Polyunsaturated fats should be a small fraction of the diet (~4% of total calories). To achieve this, do not eat seed oils such as soybean oil, corn oil, safflower oil, sunflower oil, canola oil, or the like. The best cooking oils are coconut oil, clarified butter, and beef tallow; palm oil, lard, olive oil, and avocado oil are next best. Nut butters are another possible source of fats.”)


  10. Hi Paul,

    Just a suggestion with some of the weblinks in the posts. At the moment, when clicking on a link, it takes you away from your site to the external link. It would be great if any links to external sites could be opened up in a new tab so it is easy to revert back to your site. There is always so much to read on your site, I always want to easily navigate my way back!


  11. Hi Paul,
    Thanks much for your reply to me email yesterday. As you advised needing to know my actual results to know if lipds are a problem, I wanted to share with you my numbers:

    February 2011
    Total Chol 239
    HDL 54
    LDL 144
    Triglycerides 20

    Februarly 2012
    Total Chol 256
    HDL 50
    LDL 168
    Triglycerides 190

    For blood sugar, it was the hemoglobin A1C that he tested. In May 2011 it was 6.3 and Feb 2012 it is 6.4. I do have a glucose monitor at home and most mornings the reading is 118-126 (highest Am reading was 138 and lowest was 99). This is while taking 1000 mg Metformin 2 times a day.

    Thanks again,

  12. @Anthony – which antifungals did you use? Was olive leaf the most effective?

  13. Caroline,
    You can also ‘right click’ on the link & then choose whether to open the link in a new tab or a new window.
    (at least you can on a PC, do Mac’s have a ‘right click’?)

  14. Paul,
    Have you seen this research paper? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185561/?tool=pubmed
    Looks like certain strains of herpes virus down regulate autophagy. Since herpes virus infections are so closely associated with alzheimer’s, I wonder if the downregulation of autophagy is one of the contributing factors of alzheimer’s. Any thoughts?

    I’d also like to know if fasting will counteract the effects that herpes has on autophagy, or if fasting is just not going to work to accelerate autophagy in infected cells.

  15. Darrin – you’re a star! Thanks for the tip – Ctrl-Click for right click works on the Mac. I am a relatively new user on the Mac (personal) so getting used to all the shortcuts. Thanks again for taking the time to let me know. Caroline

  16. Hello all,

    I really don’t like sweet potatoes, but in the past few days have eaten them a few times and much to my dismay they are causing intense stomach pains and upset! I am not sensitive to any other food.. and in general I eat a fair amount of starch and sugar. Now, I was reading through Paul’s post on the problems with sweet potatoes and it seems to name oxalates… I have a hard time thinking that is my problem as I have eaten more than my fair share of spinach with no problems at all. I wonder if it is more likely that is is the sugar alcohols in sweet potatoes.. I think it is mannitol? I recall a few months ago a friend gave me gummy worms without telling me they were sugar free.. I ate a fair amount of them and had some of the worst stomach pains of my life most likely due to the malitol. Couldn’t this be the same problem as with the sweet potatoes? If so, is sensitivity to certain sugar alcohols indicative of a dysbiosis of any kind? Much thanks for any insight.


  17. Paul (and others), do you think that the benefits of coconut oil could be obtained by rubbing it into the skin instead of eating it? Andrea

    Hi Andrea,

    No, I don’t.

  18. This is for PHK and the iron deficiency anemia. I battled with the problem for years and had similar problems with iron supplementation and resulting constipation, until I found Feosol Carbonyl iron supplements. They gave me no problem at all. Here is a link explaining the difference between carbonyl and ferrous sulfate iron. Hope that helps!

  19. The Feosol link won’t take. Just go to the Feosol website and look under the FAQs.

    Hi Mary, I rescued it from the spam folder. Thanks for helping! Best, Paul

  20. Dear Paul,

    I’m closing in on a year (April) using the PHD diet. It’s been a bit of a roller coaster. Initially, I just felt better, my psoriasis cleared, and after years of chronic illness, I felt there just might be a light at the end of the tunnel.

    Lately, however, I am experiencing stiffness. It even wakes me up at night around 3 a.m. My joints do not seem to be affected. My psoriasis is also back.

    This has happened before when I have done a dietary change. For example, when I went vegetarian, even vegan, symptoms cleared up, but after a time returned.

    My energy level is good. I’m eating very well, and check it on FitDay periodically. Safe starches are part of my diet, largely rice, rice cakes, potatoes, and tapioca starch to the tune of about 400 calories to 600 calories a day.

    I’ve used the charcoal and the betonite clay. I salt my food with sea salt. I’m off betonite now, but plan to do another couple of weeks on it again. I’m taking all the recommended supplements, except the therapeutic suggestions.

    I also take Armour thyroid (~90 mg. a day) for hypothyroid, but have reduced the dose to ~70 mg. due to improvements I’ve seen as a result of selenium and iodine intake. (I do 1 drop of Lugol’s daily.) When I stayed on my regular 90 mg. dose, then ends of my fingers swelled. With the reduced does, that no longer happens.

    Many of my all over body pain symptoms from my pre-PHD diet days were due to hormone issues, so I also use an estrogen/progesterone cream from Helen Pensanti, MD called Ostaderm, which was very effective in resolving that problem. The stiffness that I presently feel does not feel like my former all over body pain at all.

    This stiffness is truly an issue, as it is getting worse and it is interrupting my sleep. I first noticed it when my yoga sessions were causing undue stiffness and soreness. Then, it progressed to stiff hands, then stiff ankles and feet. Occasionally, my right hip will be stiff at night and in the morning. The knees, so far, are unaffected.

    As some people have mentioned stiffness due to eating safe starches, it makes me wonder if I need to go with less carbs. When I tried that in the past, however, I got fungal infections.

    Any insight would be appreciated. I simply don’t know what else I can do at this point.

    Thank you so much, Paul and Shou-Ching for work that benefits so many and that is given so lovingly.


    Hi Mary,

    Thanks for letting us know your progress. I have a few ideas and it will be great if you can experiment to help track this down.

    First, let me thank Michelle and Julie for their contributions below. Their ideas – hormones, infections, food sensitivities – are possibilities, but I think it would be good to investigate a few nutritional possibilities first.

    The issue of stiffness I usually associate with electrolyte deficiencies (sodium, potassium, chlorine, calcium, magnesium are the main ones). These are very common on low-carb Paleo: sodium and chloride are excreted along with nitrogen/urea when protein is converted to glucose on low-carb diets, and potassium deficiencies are very common on low-carb diets. Also, we generally recommend against calcium supplementation and in favor of magnesium supplementation, which is desirable for most people but has the potential to create a calcium-magnesium imbalance in some cases. This would show up only slowly over time, say a year, so it would fit your time scale.

    What I would suggest is that you make bone broth every week from grassfed beef bones, preferably with joint tissue and bone marrow so that the first batch is marrow and collagen rich, but continuing to boil down the bones through the week to get minerals out of them. This will supply abundant calcium and other minerals that may be missing.

    When you eat the broth, add potassium-rich vegetables, especially green leafy vegetables and tomatoes, maybe white potatoes also. You can just put the vegetables and diced tomato in a bowl and pour hot broth over it, then salt the broth and eat/drink it. Do this daily. Make sure you get enough salt, water, potassium, calcium, and magnesium.

    Continue to supplement magnesium, 200 mg/day, and try adding boron, 3 mg/day. Boron helps normalize calcium and magnesium utilization.

    That would be my first suggestion to see about the stiffness. It might help the psoriasis too.

    Re psoriasis, I haven’t studied this enough to have solid recommendations, but one possibility that I’m suspicious of as a causal factor is mitochondrial dysfunction due to membrane oxidation. This can be mitigated by certain antioxidant supplements: glutathione/NAC, selenium, vitamin C, CoQ10, alpha lipoic acid, vitamin E (as mixed tocotrienols and tocopherols), and PQQ. Again, this is pure speculation, but if the bone broth and boron doesn’t fix it, I would try this next.

    Also consider Michelle’s and Julie’s ideas, they’re good. You’ll have to experiment to find the cause, and please report back what you learn!

    Best, Paul

  21. Hi Mary,

    There is one drawback to using hormonal creams, and that is levels can build up in fat tissue, over time, & result in a frank overdose. You would need to do a saliva test to check the levels of sex hormones in the tissues.

    You might also want to check out Roadback.org for using low dose pulsing antibiotics for chronic infections. The years of chronic illness + psorasis + joint pain may be the early warning signs of full-fledged psoriatic arthritis.

  22. Julie Lewandowski

    you might check for food sensitivities. I respond to too much salicylates and phenols as well as lactose and gluten. Food and personal care products as well as other chemicals in the environment can trigger achy joints and swelling.
    If I eat too many nightshades, tomatoes, potatoes, peppers and eggplant, I will have swollen and aching joints as well as some cognitive issues, feeling spacey and self critical.
    Lactose makes the brain fog worse but not so much the aching joints, but does have some effect. If I eat dairy but take lactase, no problem. If I don’t take lactase, I have some gut cramping and also low grade joint stiffness.
    Other things such as mint, wintergreen both as flavorings or in topical products such as toothpaste or analgesic creams, aspirin, advil, can trigger achiness, dizziness, brain fog, and an odd type of fatigue where my legs feel heavy even though I have no problem with heart/respiration rate and the same exertion normally would be easy, such as climbing stairs in the house.
    Check out the site, salicylatesensitivity.com/forum/ as well as the web for information on amines and high histamine levels, oxalates and food sensitivity in general. It is due to reduced enzyme function for the amount of such foods eaten rather than an immune response in an allergy.

  23. Hi Paul,

    I was wondering what the most important micronutritious foods are if you are intolerant to dairy,eggs, and nightshades?

    Hi Jonathon,

    Eggs are an important source of phospholipids so it’s important to replace those with organ meats like liver and kidney.

    Dairy and nightshades aren’t really unique as far as their nutrient content so you have a lot of choices.

    Best, Paul

  24. Hi Paul, something is perplexing me that I hope you can help me with. Among many of the benefits of giving up gluten completely has been the disappearance of a life long dental plaque problem (I’m currently 51); a problem so bad I needed to have my teeth cleaned every four months to keep my dental hygienist happy. I understand that plaque is a biofilm of streptococcus mutans. I also understand that this same bacteria has been implicated in heart disease, see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1594668/?tool=pubmed which would be an interesting blog post in itself. What do you think is the mechanism for the plaque disappearance as that strain of bacteria is obviously still living in my mouth? Do you think wheat causes a change in PH that inhibits beneficial bacteria from keeping S. Mutans at bay? Does it, as a matter of course, favor pathogenic bacteria over beneficial bacteria? Or does H2 gas from fermentation of wheat feed S. Mutans as it does H. Phlori in the stomach? Or is there some other possible biological explanation you think is behind this positive outcome? I’m curious to hear your take on this.

    Hi Ray,

    I don’t know the answer, but I can say it may be a bit complicated. First, there are many other cariogenic microbes besides S. mutans, such as Candida. Wheat damages the quality of bones and tooth enamel, and this may promote microbial penetration and biofilm formation. Removal of wheat may have improved the quality of the teeth, depriving bacteria of living space. But there could be many possible explanations.

    All we know for sure is that it’s good to remove wheat from the diet!

    Best, Paul

  25. Hi Paul,
    Remember I said my tongue was yellow? I think it was just because I took a heavy load of turmeric in my diet. Now that I’ve laid off the turmeric it’s more white. So it’s probably thrush.

    My doctor, dentist, ENT all said don’t worry about it…..

    But I don’t think thrush is normal and I’d like to get rid of it.

    I’m on PHD and upping the coconut oil and garlic. I don’t know what else to do. Should I buy probiotics?

    Thanks for your help, Paul.


    Hi Nick,

    The two leading possibilities are a fungal thrush and a leukoplakia from a deficiency, probably vitamins A and B12 are most likely on PHD. You could up egg yolk and liver consumption and take supplemental B12 to see if those help.

    For fungi there are many antifungal foods, including most vegetables esp green leafy vegetables, garlic and onions, herbs such as oregano, vinegar, berries, and oils such as coconut oil and olive oil. You can also ask your doctor for antifungal medicines, they worked well for me.

    Upping the carbs a bit and limiting alcohol may also help.

    Best, Paul

  26. Low Carb hyperglycemia checklist? I am looking for a checklist of things to try to combat persistant hyperglycemia despite 8 months of strict low carb +safe vegetables. Thanks

  27. Couple of quick questions:

    1. When we talk about toxic qualities of grains… does that apply to beer or say rye whiskey?

    2. I had an allergist run a bunch of skin aka “pric” tests.. like north of 100. He said I reacted to tree pollen and dust mites but not any foods. Would a celiac or someone with a wheat “sensitivity” always react to a skin test? Is this an apples to oranges thing when talking about skin reactions and digesting something?

    1+2=3: So can a celiac/wheat sensitive person consume beer/whiskey? Or is it a matter of degree?

    I’m almost 100% grain free except for an occasional beer. I’m trying to determine if those occasional beers have anything to do with flares of dry itchy skin… aka Atopic Dermatitis aka Exczema.

    4. I’m not even sure I am wheat sensitive. But If I am, it seems the toxicity of a small dose could set things off since I never touch the stuff. I’ve kind of adopted the philosophy that everyone is allergic to the stuff… just a matter of degree. Is there a surefire way to determine what your degree is?

    Sorry… not as quick as I originally thought. Thanks

  28. Hypothyroidism?


    If this amounts to anything, I owe you big time. After reading PHD sections regarding low thyroid function and symptoms, I urged my doc to run the tests. Haven’t talked to her yet, but got these dimensionless numbers over the phone:

    TSH 4.94
    T3 2.8
    T4 .79

    The tech said doc had noted “elevated.. discuss pro/con of medication.” Very disappointing, considering your advice to shoot for TSH less than one. What do you consider normal ranges for these values? From my quick research, my TSH is way above new 3.0 limit for hypothyroidism, and both free T3 and T4 are either below limits or very low normal.

    Other symptoms: tired, fatigued, stressed, lazy, cold intolerance, thinning of outer 1/3 eyebrows, dry/itchy skin, difficulty w/ weight, irritable.

    History: 46 yrs old. 6 ft. Many years following conventional low fat/eat toxin wisdom and avoidance of fat. Chronic cardio and yo-yo weight. Lousy sleep schedule (job). Weight Watchers got me from about 240 down to 185 lb for a while about 6 years ago. Back to about 220 a year ago before learning about Paleo (Swiss Paleo actually.. ha just learned that term) and effortlessly loosing 1 lb/week and back to 195. Then last fall, confident of progress, I allowed some cheats: occasional basket of corn chips or a chicken quesidilla, and beer. With the hollidays I found myself back around 210 before reading PHD. Also stopped smoking in January… which was never a good alternative to my long nicotine friend smokeless chewing tobacco… so it’s a change being nicotine free also.

    My Swiss Paleo was VLC. After reading the fun blogs here and with Anthony… I now realize I was too low carb. Since following PHD, and adding safe starches, and following PHD supplementation I have noticed some changes over previous 6 weeks: cold intolerance improved, gained about 8 lbs, more sweat, better skin (maybe the weight gain is water?).

    I just upped my Iodine to 2g per your protocol. The above blood was taken after about 2 weeks of PHD supplementation at 1g Iodine and 2 Brazil nuts/day (since switched to pill for selenium).

    So, If I had to guess I’d say some things are working. A bit disappointed w/ weight gain, but I guess that’s ok for now as I’ve heard you say it’s better to get healthy first, and you told someone above it could be dangerous and hard to loose fat with low thyroid function.

    Just wanted to see what your thoughts where at this point. Specifically:

    1. How bad are my numbers?
    2. Should I continue without medication?
    3. Should I request antibody test?
    4. If medication, any recommendations on specifics?
    5. If no medication… how high do I take Iodine supplementation. Book is a little unclear. Is 5 g a good target?

    Thanks again. Sometimes I feel like a hypochondriac or something, but it just feels like something has been off for several years… like I’ve been in a rut and I can’t get my groove back. If this thyroid thing pans out and I can be happier, less irritable and keep the fat off… wow.. THANKS again.

    Hi Andrew,

    1. Bad enough that you should track this down and focus on it.
    2. If you have all the hypothyroidism symptoms that you list, then I would take replacement thyroid hormone and see how much you need to optimize how you feel. Then work on fixing things so that you can steadily reduce that dose.
    3. Yes, absolutely.
    4. Most doctors will have you start on T4 only, levothyroxine. Most patients with severe hypothyroidism do better with some T3 mixed in, but if the case is mild it’s better to stick to T4 only. Try to find the lowest dose that makes you feel normal. Don’t be afraid to cut pills in half to test lower doses than your doctor prescribes.
    5. Iodine – I don’t think you should be raising iodine dose until you know your situation better, and until you have been on a non-selenomethionine form of selenium for a while. I would stay around 1 mg, or 2 mg if you feel better there, and be consistent.

    Best, Paul

  29. Paul said:

    5. Iodine – I don’t think you should be raising iodine dose until you know your situation better, and until you have been on a non-selenomethionine form of selenium for a while. I would stay around 1 mg, or 2 mg if you feel better there, and be consistent.

    Best, Paul

    You lost me there. Was doing Brazil nuts initially, and just switched to a Selenium Yeast from pill. And I found this: Most of the selenium in these yeasts is in the form of selenomethionine. Your rec page has three options: one is a selenium yeast and the other is a selenium citrate and third a complex?

    Thanks again for all the above. Will get with doc asap.

    The Brazil nuts were all selenomethionine, and the new one is part selenomethionine. That may not be useful. So you want to be on 200 mcg of non-selenomethionine selenium for a while.

    Best, Paul

  30. Paul
    I try to follow the perfect health diet and have removed all wheat,grains, and toxic veggies from my diet for about 3 months. I also eat towards the lower carb end of the phd spectrum for about 8 months as I feel better but fasting sugars wont budge. I have improved many markers of health losing 40+pounds, feeling great, and very clear thinking. I posted earlier looking for a checklist to see if I am overlooking something as there are great ideas all over your web site.

    Hi G,

    It’s great that you’ve lost 40 pounds and feel great. If you want me to say anything about your fasting blood glucose, you need to tell me what it is, whether your doctor has diagnosed you with diabetes, and such things. At low carb intakes such as yours fasting glucose tends to be slightly over 100 mg/dl in healthy people.

    Best, Paul

  31. Thank you, Paul, Julie and Michelle,

    I don’t think my problem is food, as I have ruled that out over the years, but certainly a consideration if one hasn’t. Going gluten free did the most any food elimination could do for me. The results were amazing.

    The hormonal cream will require a second look, as I am past menopause now and perhaps I don’t need as much or any now.

    My ears, however, “pricked up” when I read this Paul: “The issue of stiffness I usually associate with electrolyte deficiencies (sodium, potassium, chlorine, calcium, magnesium are the main ones). These are very common on low-carb Paleo: sodium and chloride are excreted along with nitrogen/urea when protein is converted to glucose on low-carb diets, and potassium deficiencies are very common on low-carb diets,” as I was diagnosed with a potassium deficiency a year ago at my medical exam, and told to eat bananas. The last test it was okay, but perhaps I’m trending down again, as I don’t like bananas much. I will DEFINITELY try your nutritional suggestions and report back.

    I had checked with you about supplementing with calcium and magnesium and strontium citrate due to an osteopenia diagnosis. I turned the diagnosis around before and hope to do it again. Doses are 1000 calcium and 500 magnesium in divided doses, as we can’t absorb more than 600 mg of calcium at a time. I’m pleased the supplement also has boron as per your recommendation.

    In the meantime, I am doing Wobenzym N to help with the stiffness. I used it before and it does help, but is too expensive to use all the time. It is certainly preferable to aspirin, Ibuprofen and Tylenol.

    Ultimately, my goal is to find the cause and fix it nutritionally.

    I’ll report back.

    God bless!

    Hi Mary,

    You have to eat your vegetables! Tomatoes, potatoes, and green leafy vegetables are other good sources of potassium. I don’t care for vegetables much either, but find that all of these are easy to eat in bone broth. Just dice up the vegetables in a bowl and pour hot broth over them, salt it, and eat it as a soup.

    Good luck and please let us know how things go, what works and what doesn’t.

    Best, Paul

  32. Paul,

    my fasting blood glucose is around 160 down from about 200 before phd, i had been told by dr. that i was borderline diabetic and took metformin for awhile many years ago but stopped due to side effects.
    Thanks for all that you and yours do!

    Hi G,

    That doesn’t sound borderline, it sounds severely diabetic (see http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/). I’m glad you’re fixing your diet.

    Since you’ve only been on our diet for 3 months and have seen substantial improvements, I don’t see any reason not to expect further improvements. Usually health improves for several years after the diet is fixed.

    I would try to be even more careful than you have been about keeping omega-6 fats and fructose down. But the biggest gains are probably in nutrition. You might consider some of our “therapeutic” supplements, like B vitamins (B1/B2/B5/B6/B12/biotin); eat 3 egg yolks a day for choline. Minerals including chromium are important; be sure to take a multivitamin daily. Eat & drink bone broths.

    Then, try to exercise. Walking is a good start. And be sure to tend to circadian rhythms – sleep in a totally darkened room; wake naturally; get sun exposure, exercise, and social contact during the day.

    It sounds like everything is going well. Healing takes time. If you do end up plateau-ing, then the next place to look would be for some sort of digestive tract infection. There are diagnostic tests you could do to look for that. But you haven’t told me anything but good news, really, so I would just stay on course!

    Best, Paul

  33. Mary,

    Thanks for the tip.

    This is the first I’ve heard of Wobenzym N. I read above you only take it occasionally because of the cost, but would it work better if you were to take it routinely? It is expensive, but if it works, it would be worth almost any cost to me.

  34. Food or Not Food?

    My kids convinced my parents to buy a bag of “veggie chips” w/

    Hi Oleic Expeller Pressed Vegetable Oil (Sunflower and/or Safflower and/or Canola Oil)

    It claims 0g PUFA!?

    Hi Andrew,

    The Hi Oleic versions of these oils may be only 10% PUFA, and the labels allow rounding to the nearest gram, so if they have 0.5 g PUFA per serving, then the label will say 0. I would read that as 0.5 g.

    Best, Paul

  35. For erp: I used the Wobenzym N until I had my pain under control. After that, I did not need it. The stiffness issue is a new one, so I’m trying it for that. Still, I’d rather not have to rely on pills for good health.

    For Paul: I DO eat my vegetables! I’ve been a gardener for over 30 years, plus I can and freeze my own vegetables too. I even eat bananas, but don’t really like the texture.

    All my doctors have claimed something is wrong with my immune system, but can’t seem to track it down. PHD diet has done the most for me. I’m going to keep chipping away and hope for a drug free old age. So far so good, Armour thyroid is all I take, and I’m working on reducing that, thanks to you!

    Have a good week!

  36. Hi Paul,

    I’ve read through Perfect Health Diet a couple times and I have to say it’s the best book on nutrition I’ve read. Your use of logic and science is as good as it gets.

    I have a question about human breast milk as a clue to optimal macro ratios. If human breast milk is composed of ideal macro ratios for humans, do the macros of the milk of other animals differ to suit the needs of that specific animal as well?

    Using a primate as an example that consumes a majority of their diet as carbohydrate, is their milk higher in carbohydrate because the diet of their species is higher in carbohydrate? Or is it more complicated than that due to their gut.

    Thanks for your time.


    Hi Ryan,

    It’s a good question. Human milk I believe has the highest carb content, due to our larger brains. Animal milks tend to be higher in protein than human milk. But I haven’t studied a very large range of animal species. It would be interesting to look into.

    Best, Paul

  37. I have a very high ferritin level, at 330 ng/mL. The lab reference range is 18-320 ng/mL for adult males. Anthony Colpo is a big fan of iron reduction and says high ferritin is extremely correlated with heart disease. Any suggestions about whether I should seek treatment or what might be causing such high levels?

    Hi Jeremy,

    I agree that it’s best to have lower iron levels. Many pathogens benefit from high iron levels.

    Ferritin is a storage form and it is upregulated during infection to keep iron away from pathogens. So high levels could indicate either an excess of iron, or upregulation of that iron-storage immune response (or both).

    From what I understand, you can get a better picture of iron status by measuring, in addition to serum ferritin, serum iron and total iron binding capacity. The ratio of serum iron to TIBC is called transferrin saturation, and it is high when iron load is high.

    Blood donation is the easiest way to eliminate high iron.

    Best, Paul

  38. Hi Paul,

    I was looking over your paleo summit presentation and I understand you had a huge caloric intake due to ravenous hunger when you had scurvy. I have had a similar problem, in regards to a big appetite and caloric intake, but I have been unable to figure out what it was. I doubt it’s scurvy but I was debating the possibility of celiac, or at least some kind of gluten intolerance. I have a dermatitis herpetiformis rash on my buttocks and legs, as well fatigue that has become increasingly bad–i’m in my 20’s and need a nap everyday or bunches of coffee, and even then I have lots of difficulties concentrating/being active. I also have a very strange pattern that occurs whenever I try to eat healthy: I can’t seem to sustain it for more than 4 days, i get extremely fatigued and end up eating a ton of wheat calories–i feel much worse when I do that, but the next day I’ll feel like I have more energy than usual. I was wondering if this is a pattern that resembles celiac or gluten intolerance at all. Thanks again for sparing your time for this question!

    Hi Jonathon,

    A mysterious set of symptoms and I don’t know what it is, but I do think a stool test is warranted to see what pathogens are present in your gut.

    I noticed when I was on antibiotics that gut flora can have a huge impact on appetite. (My food intake increased considerably while on antibiotics.) So a gut dysbiosis might explain the appetite part.

    Best, Paul

  39. Hi Paul,

    I bought your book and I want to thank you. I feel better. I have a question about gut infections. I’ve read your posts and comments and I haven’t seen this addressed. I have an unusual reaction to probiotics. They give me heart arrythmia and palpitations. I tried GAPS last fall for chronic constipation. It helped but I had severe heart palpitations and two episodes of paroxysmal atrial fibrillation. I also seemed to develop a reaction to the dessicated thyroid that I was taking at the time so it is hard to tease out the precise cause. I think I have a gut infection and I’m trying to figure out what kind. Maybe these symptoms and background information will help. I have Hashimotos’s thyroiditis and I had a thyroidectomy for papillary thyroid cancer almost 2 years ago. I became very hypothyroid because I didn’t have medication for 8 weeks. I’m assuming I received intravenous antibiotics as part of the surgeries and the one day hospital stay. I did not have radiation. I was preparing for it but it turned out I didn’t need it due to a second opinion. My TSH was 134 when I started the dessicated thyroid and my thyroid numbers were good for 9 months. I’m currently on tironsint, which is a synthetic T4 with no filler or dyes. It’s a gel cap and my TSH is coming down to where it should be. My digestion is not and it hasn’t been good since about a month after my surgery almost 2 years ago. Before my surgeries I had eliminated gluten, dairy, and eggs from my diet with good result. I also started taking Vitamin D-3 and selenium cysteine. I also take astragalus to balance my immune system. I worked with a chiropractor trained by Datis Kharrazian and his protocal really helped my autoimmune symptoms. After my surgery, I developed loose stools and then constipation, it varies, with constipation being more dominant. More fat and cutting out starches and sugars has helped but I found that I do need safe starches for the T3. I’m currently consuming 600 calories a day of safe starches. Fruit makes up 100 of those calories. I eat over 5-10 servings of vegetables a day and plenty of fat from sources that you recommend. I added in vitamin K, magnesium, acetyl cysteine, and vitamin C after reading your book. A herbal supplement from apex energetics called GI synergy for gut infections and parasites made a noticable difference relieving the constipation. It has a broad spectrum of herbs and I’m not sure which ones helped. I’m still having funny gut symptoms however. Now my stools are very loose and I still miss a day here and there. My energy, memory, and concentration haven’t fully returned yet. Probiotics help but I can’t seem to tolerate them, they give me heart arrythmia and palpitations. I’ve tried a number of different brands. I even tried l. reuteri recently per your supplement suggestions. I’ve tried taking really small doses and I still get arrythmia after a few days and it is severe. The probiotics are the only variable. The heart symptoms disappear if I cut out them out. Probiotic foods don’t seem to cause a problem. Why are probiotic supplements causing heart paplitations and arrythmia? Do the probiotics stimulate an autoimmune flare up and attack on my heart? Is it a die off symptom? If it is a gut infection what kind of gut infection is it? Is there a way I can determine the cause of this and address it? I felt really good two years ago before my surgery and I want to feel that good again.

    Hi Cathy,

    I’m afraid I’m as puzzled as you are why the probiotics cause arrhythmia. Bacterial lipopolysaccharides can do that, but why probiotics and not fiber? Perhaps endotoxins produced in the colon do not enter the body, whereas you have a small bowel problem and bacteria there can cause trouble.

    I think this is really a diagnostic problem for your doctors. I would suggest a stool test like this one: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology. Other diagnostic steps for small bowel issues, such as an endoscopy or SIBO breath tests, might reveal something.

    If we assume the problem is due to circulating toxins generated in the gut, then possibly detox aids like activated charcoal or bentonite clay, plus glutathione support for the liver, will help.

    Best, Paul

  40. Hi Paul,

    When you came to speak at Crossfit NYC you mentioned a recipe for electrolyte water. What were the proportions?


    Hi Christian,

    A food based drink would be:
    Bone broth (calcium, phosphorus, some magnesium);
    Sea salt (sodium, chloride);
    Tomatoes, potatoes, green leafy vegetables (potassium)

    It would only need a source of additional magnesium which could be a supplement or a pinch of epsom salt or a few drops liquid magnesium citrate.

    The one I mentioned in my CrossFit NYC talk used non-food ingredients you can buy in a store:

    1 tsp sea salt
    1/2 tsp “No Salt” (potassium salts)
    1/4 tsp Epsom salt (magnesium sulfate)
    1/2 tablet Tums (calcium)

    I think the food approach is better, generally.

    Best, Paul

  41. Thanks Paul. I’m going to look into getting that test. I looked at the symptoms for SIBO and they match. It’s associated with hypothyroidism. I found a study that showed an association between SIBO and atrial fibrillation. Can probiotics cause or exacerbate SIBO?

    I’m hesitant to take charcoal or bentonite clay for fear they will effect absorption of my thyroid medication. Is that a valid concern? I am taking 500 mg of acetyl choline and 1000 mg of vitmain C per day for glutathion. Would you suggest taking more?

    SIBO can be related to a poor housekeeping wave. It’s a vicious cycle because one of the things that weakens the wave is bacterial overgrowth. Is there something I can do with my diet or something I can take that will get a strong housekeeping wave started again? Are antibiotics the only, or best, option. Thanks.

    Hi Cathy,

    Anytime you add bacteria to an existing bacterial colony there will be a fight and some dead bacteria, so, yes, probiotics can create a disturbance in SIBO.

    I don’t think you necessarily need a lot of charcoal or bentonite clay. You can take them once a day 12 hours apart from your thyroid medication. They shouldn’t interfere much.

    500 mg N-acetylcysteine and 1 g C are a reasonable starting dose. You can experiment with more.

    I’m not sure what you mean by housekeeping wave, but you can try to increase stomach acid by taking betaine hydrochloride and extra salt; and you can take antimicrobial herbs. Most traditional herbs and spices are antimicrobial.

    Best, Paul

  42. Hey, Paul.
    I’ve been Paleo for over a year now and your book changed everything for me. Thanks for all you do for this community as well.

    I am going home for Spring break next week and want to get some tests done to see what’s wrong with me. I am very limited financially, so I wanted to get your opinion on my condition before I spend thousands of dollars on tests.

    Basically, I went vegetarian for about 5 months a couple of years ago. Within a month or so, I developed a skin condition that I have yet to figure out. I get outrageously itchy skin (mostly at night) that starts in my feet and legs and spreads up from there. There are no rashes or bumps where the itching occurs, but when I scratch it, it gets very red and more itchy. Upon visiting the doctor about this, I was given no explanation and prescribed an antihistamine. For the longest time, the antihistamine was the only thing that provided relief from the itchiness, but I had to take them religiously.

    Last fall, I started researching Candida and thought maybe that was the problem. I cut out fruit and sugar, keeping safe starches as my only carb source. I purchased several anti-fungals as well as bentonite clay. Like the antihistamines, the anti-fungals provided temporary relief from the itchiness. However, even after several months of taking them and the clay, my condition has not improved at all and I have had no die-off of any kind. This makes me wonder if my condition is fungal at all.

    Other problems I’ve had for a while include constant bloating, low body temperature (~96.5), chronic fatigue, muscle weakness, low stomach acid, and some acne.

    What do you think could be going on here? Do you have any recommendations as to what I should test myself for?

    Thanks so much for reading my long winded post. I hope you can provide some ideas.

    Hi Spencer,

    Itching is very hard to diagnose, but the other symptoms – bloating, fatigue, hypothyroidism, low stomach acid, and acne – are all the most common symptoms of gut dysbiosis. It looks like you have some sort of gut infection.

    I like the metametrix microbial ecology test – google it. It’s about $180. That should provide enough information to guide a treatment decision. You might read our “Bowel Disorders” category too.

    Best, Paul

  43. Paul,
    Thank you so much for your advice. I’m going to look into that test and report back as soon as possible.

  44. Spencer,
    I had a problem with itching legs late at night. I finally realized it was a new shampoo that I was using. (Took me a while to figure it out because I used the shampoo in the morning, but the itching was really late at night.) Anyway, something to think about if you recently changed soaps, detergents, shampoo or conditioner.

    By the way, I’m now using the “poo less” method of washing my hair – several weeks now – and it’s working well! (Most methods use baking soda and water mixture to clean and then rinse with an apple cider vinegar and water mixture. I may stop using the rinse on my hair though – it’s not easy to comb my long hair out.)




  45. I should have said that we have well water – hard water with lots of minerals, so that could be why the apple cider vinegar (ACV) rinse doesn’t work well for me. My hair seems to have a better feel before using the ACV. I think it works well for most people, according to what I’ve read about it.

  46. Connie,
    Thanks so much for your suggestion. Unfortunately, I stopped using soap and shampoo of any kind over a year ago and it has not helped at all. I’m almost certain it was something that developed as a result of me going vegetarian, but I’m still trying to figure it out. I got several infections around that time too, so my immune system must have been and/or still is very weakened.

  47. Hey Paul
    I’ve recently heard about a possible association with eating cassava/tapioca and pancreatitis. Do you know if this is a legit concern? A google search yielded mixed results, so i’m not sure if I should cut down on my intake of tapioca flour

    Hi remo,

    The literature doesn’t seem to support a risk. Eg http://www.ncbi.nlm.nih.gov/pubmed/21922874, “TCP patients are at higher risk of defective detoxification of cyanogens. However there was no difference between cassava consumers and non-consumers.” In long-term studies in rats there was no pancreatitis, http://www.ncbi.nlm.nih.gov/pubmed/10952402, “In conclusion, chronic cassava ingestion up to a year does not lead to either diabetes or chronic pancreatitis in the rat model.”

    Tapioca, the starch extract of cassava, is safer than cassava because it lacks the proteins. So I wouldn’t worry about tapioca.

    Best, Paul

  48. Hi Paul,

    I’m sorry to trouble you – I realize that there have been an overwhelming number of posts / questions here over the past few weeks. If you do however get a chance, I would be very grateful to hear your thoughts on my post made on February 18th.

    Thank you once again.


    Hi Adam,

    I responded in that comment, here: http://perfecthealthdiet.com/?page_id=4228#comment-56365

    Best, Paul

  49. Hi Paul,

    I think we all really appreciate the support you offer and understand that you are very busy. I had written before about a problem with my teeth and am wondering if you would have any advice/insight. I’ve been dealing with several different autoimmune diseases. I’ve been following your diet as well as taking all the needed supplements. I still seem to have severe acid – constantly burning my throat – I have a legion because of it. The main problem is that it’s destroying my teeth. I’ve had about 20 cavities in the past year and a stain is constantly being formed. It’s just a surface stain (ie the dentist can remove it easily). Originally, I thought it was vegetables with high levels of sugar creating some sort of film but that doesn’t seem to be the case since I have removed all vegetables with high sugar.

    I’ve been taking a product called ph balance, doing proper food combining, digestive enzymes, etc. I’ve also just been brushing with baking soda. I’ve tried using peroxide, oil pulling, and salt.

    Any help would be appreciated.

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