Q & A

Q & A

This page as an open thread for reader questions, especially questions about personal health concerns.

I am putting this page up as a way to share knowledge — my knowledge with questioners, but also so that others with similar concerns can read the conversation, and readers with relevant knowledge can chip in with their own thoughts.

Please keep in mind that I can’t research questions in any depth, so my answers should be considered tentative, incomplete, and subject to later correction. Also, I am not a doctor, and nothing I say should be construed as a substitute for medical diagnosis and treatment. I am only sharing opinions about disease origins and general therapeutic strategies which may or may not be applicable in any given case.

To get the page started, I’ll put up a few questions from recent emails. Here is an index by disease, with clickable links:

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


Been following your work on the PHD before the publication of the book and commented on my CLL and the usefulness of Vitamin D once on your blog and you responded to keep an eye on my Vitamin K intake, which I do now.. Am fortunate in a way to have my form of CLL as it indolent which gives me the opportunity to experiment without the pressure of undergoing conventional treatment. The PHD, I think, is helpful in this regard.

Wonder if you could point anything out to me that may be useful. Anything at all. And I will be happy to share with you my results.

Surely you know of the helpfulness of green tea with CLL. You may not be familiar with research that points out that those with low levels of Vitamin D need treatment for CLL far sooner than those with elevated levels.

Feel strongly that your version of a ketogenic diet would be helpful but also feel I need some direction in this area. Do you have any suggestions?

Warmest Regards,


Hi A,

I remember your comment, thanks for writing back. I’m glad you’re enjoying our diet and wish you the best.

Thanks for the tips about green tea and vitamin D. Neither one surprises me.

Most likely CLL is caused by a viral infection. So enhancing viral immunity is probably a good idea. Good strategies may include: (1) low-protein dieting, which inhibits viral reproduction and can promote autophagy; (2) maintaining high vitamin D levels; and (3) intermittent fasting, which promotes autophagy.

Some food compounds have been reported to have antiviral effects. An example is green tea catechins, eg http://pmid.us/16137775, http://pmid.us/18313149, and http://pmid.us/18363746, and this could be why green tea is helpful against cancers, http://pmid.us/21595018, which are usually viral in origin.

I might search Pubmed for herbs and spices with antiviral effects, and use them abundantly in cooking, along with antiviral foods. Turmeric / curcumin is a good choice, this needs to be taken with black pepper to enter the body. See http://pmid.us/21299124, http://pmid.us/20434445, http://pmid.us/20026048.

Coconut oil / lauric acid also has some antiviral properties, so inducing ketosis with coconut oil could benefit you even aside from the ketosis. You could also try monolaurin supplements which may enter the body better and which some people have reported to help viral infections.

You might also try HDL-raising tactics as discussed in this series: HDL and Immunity, April 12; HDL: Higher is Good, But is Highest Best?, April 14; How to Raise HDL, April 20.

Another possible tactic is high-dose riboflavin with UV exposure on the eyes. This requires going outdoors at midday and not wearing glasses or contact lenses. Riboflavin+UV is toxic to blood-borne viruses, and the retina is a location where UV can reach circulating blood cells. Sun exposure will also help you optimize vitamin D.

That’s a few ideas, at some point I’ll do some research to come up with more and do a blog post. Do keep me posted on your results!

Best, Paul

Bloating, acid reflux, anxiety, depression, hypoglycemia, hypothyroidism, fatigue

Just came upon your website and had a question for you. I have had some health concerns for the last four years, bloating, acid reflux, anxiety, depression, hypoglycemia symptoms, female complaints (I am in my forties), thyroid antibodies at 333, weight gain around my middle and too tired to work out like I once did. I used to be fikiiled with energy and great health no depression or anxiety. My doctor thinks these symtoms are all from peri-menopause and wants to treat me with Zoloft.

Needless to say I have tried to avoid the Zoloft. I have tired every avenue out there to cure myself. Most recently the Primal type diet. When I eat no grains or dairy I get horrible hypoglycemia symptoms and don’t feel great like everyone else on a low carb diet. I feel weak and more anxious. Do you think your diet would be easier for me with the addition of rice and potatoes?


Hi G,

Yes, I do think our diet will be better for you. You should eat enough starches to avoid hypoglycemia.

The key thing for you is treating the infections which are consuming so much glucose and making you glucose-deficient if you don’t eat enough carbs. Whatever pathogen(s) this is, it seems to have infected your gut and caused the various gut problems; circulating pathogen-derived toxins and immune cytokines are probably responsible for the anxiety and depression. Hashimoto’s hypothyroidism may be either due to circulating toxins or a thyroid infection.

I would suspect some kind of protozoal or parasitic infection due to the hypoglycemia, but what I really recommend is getting your doctor to have a stool sample analyzed for pathogens. Metametrix has a good test. Once you know what pathogen to treat, and get on a better diet like ours, you should improve quickly.


I am writing on behalf of my mother … We live in Dhaka Bangladesh …

Before her illness, my mom was 105 lbs, 5 feet tall and always 10ft tall in spirit…. When she was diagnosed with Lupus at the age of 30, we were all overwhelmed and out of our depths. My beautiful, athletic mother was in a wheelchair and given 6 months to live….

The doctors has advised her to eat literally nothing, minimum protein (1 small piece of chicken/fish, limited to 20g protein per day), only 2-3 types of vegetable and 2-3 fruits and of course lots of carbs to apparently compensate for her failing KIDNEY and LUPUS. She is on tons of medication, no food except the wrong foods (carbs) and in chronic pain. She currently weighs 139 lbs.

Please advise. — S

Hi S,

I believe lupus is a catch-all diagnosis for a variety of conditions which are probably caused by undiagnosed infections. In the US the infections are usually bacterial. I’ve known several people with diagnosed lupus who were cured by antibiotic treatments – in one case the problem was Lyme disease (Borrelia). I have no idea what the likely pathogens would be in Bangladesh. If she does better on low carb and coconut oil, that indicates bacteria; if she does better on high-carb, that indicates protozoa.

A healthy diet is very important. It is very bad advice to “eat literally nothing,” it is essential to be well nourished. Protein is necessary for healing and immune function, and 20 g/day is too little. Fasting is good, but it should be intermittent – not starvation! She needs healthy fats, more protein, and lots of micronutrients. Eggs, shellfish, seafood, bone broth soups, vegetable soups, and fermented vegetables may all be helpful. Coconut milk is probably good for her. You should basically follow the program in our book.

I would try to put her on a good diet, give her a little time for kidneys and other tissues to heal, and then try antimicrobial medicines. Usually, if they’re not working, then you don’t notice an effect. Any strong effect, good or bad, means they are working. Bad effects mean that pathogens are dying and releasing a lot of toxins as they disintegrate. If this occurs, detox aids (salt, water, and one of cholestyramine/charcoal/bentonite clay; also glutathione supports and vitamin C) will help.

Please stay in touch and let me know how things go.

Best, Paul


Jersie wrote:

I’ve suffered from depression for decades. A few months ago, I decided to try the Dr. Kruse protocol for jumpstarting leptin sensitivity and 2 interesting things happened.

When I went very low carb – below 50 gm -. I had half-day periods where the depression suddenly lifted (something that has rarely happened otherwise). However, I also suffered from darker than normal periods.

I stopped the Dr. Kruse protocol after 6 weeks, and went back to regular paleo (approx. 200 – 300 gm. Carb/day). I’m now generally more depressed than usual, without the good periods.

These changes seem to indicate that I can have an influence on my depression with diet, but not sure what diet to try. Thoughts?

Hi Jersie,

I think your experience on very low carb is diagnostically telling.

I would interpret it this way:

  1. Your depression is caused by an interferon-gamma mediated immune response in the brain, probably caused by a viral or bacterial infection. This leads to tryptophan being directed away from serotonin and toward the kynurenine pathway. So you have a serotonin deficiency and kynurenine excess.
  2. A ketogenic diet is both therapeutic (promotes immunity against bacterial and viral infections) and mood-improving (clears kynurenine).
  3. However, you are at risk for hypoglycemia in the brain (especially if the infection is bacterial) and hypoglycemia causes irritability/anxiety and can aggravate depression.

So the very low-carb diet had mixed effects (ketosis, hypoglycemia).

What I would do is follow our ketogenic diet advice. Eat at least 50 g/day carbs from starches to get sufficient glucose, plus sufficient protein to reach 600 calories/day protein+carb, but add in large amounts of MCT oil or coconut oil. Also, do intermittent fasting – eat all the carbs within an 8-hour window; eat at least half the MCT oil in the 16-hour fasting window.

Once on a good diet, I might experiment with antibiotics to see if they relieve symptoms.

Please let me know how things go.

Leave a comment ?


  1. Hi Raham,

    There’s a couple of comments from Paul upthread that you might want to read (search for them using Ctrl and F) but basically Paul doesnt rate food combining or brushing with baking soda.

    Is the acid related to GERD? Chris Kresser has several articles on GERD on his website – you might find some good info there:

  2. Hi Paul,
    I came upon our site thanks to google after trying a few diets to try and help with digestion and sleep. I’m thin but my belly would be distended with no pain just some growing noises and gas. My bowel movements are daily and this bloating would sometimes start after a bowel movement ! I found some other people with similar problems on google but no clear answers. I tried low carb paleo and this helped with the bloating. However, my sleep quality deteriorated and I would tend to get up early in the morning after about 5 hours of sleep and feel tired after that.

    Eating a big meal at night with lots of carbs including wheat puts me into a coma like state but does help me sleep through the night. The next morning I tend to have a large bowel movement which now makes sense after I heard your interview with Dr Mercola in which you talked about wheat having such an effect.

    I tried melatonin and other sleep aids with different doses but they tend to make me groggy and feel hung over in the morning. So I was wondering if you have any advice for sleep maintenance? Have you heard about the lady who advices eating a potato at bedtime and protein at other meals ? I was thinking of trying out that approach even though that was focussed on depression but looks like it helped people with insomnia.


    Hi Narain,

    Sleep disturbance is caused by immune activity, bloating by activity of gut pathogens. It seems likely that the same gut infection is causing all of your symptoms, and changing the pathogen’s food is what changes the pattern of symptoms.

    I don’t recognize the specific pattern of symptoms you have. So in your case I would recommend getting a stool test to diagnose the pathogen(s). This is a good one: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology. Depending on the results, you would treat the specific pathogens that turn up, and maybe adjust the diet.

    Depending on the pathogen there are various things that may help, but rather than guess/experiment I would recommend starting with a diagnostic test.

    Best, Paul

  3. Hi Paul, I just started reading the book, however, I have a few questions.

    1. Why ban sugar completly, yet allow for other sweeteners? In my view, sugar cane based products may be safer than some of the highly processed alternatives. Recently, Dr. Oz nopted the presence of arsenic in organic rice syrup, Dr. Mercola warned of overprocessed honey, and I believe I’ve heard about similar processing concerns with agave and HFCS. I use raw, locally produced honey, and a little organic sugar in my coffee. Is this really a sweeter type issue, or a consumption amount issue?

    2. Last year, I dropped 25 pounds using “The Four Hour Body” by Tim Ferris. However, I did experience some cloudy thinking, probably because of the complete lack of sweeteners and simple carbs. But, I did learn to appreciate beans for the very high level of antioxidants. While I wouldn’t choose to eat soy based products, or raw or highly processed beans of any kind, I don’t understand your complete ban on beans. The text in the book simply doesn’t go far enough to convince me that all beans and bean forms are bad.

    I have gotten into the habit of cooking organic beans “from scratch”, often the beans are either soaked overnight or cooked twice, removing soaking or first cooking water. Given the great abundance and cost effectiveness of beans, combined with the potential nutritional value, does it really make sense to throw the beans out with the bathwater? Do you have a case for this beyond what was written in the book?

    I look forward to trying the diet, and your response. Best, Denise

    Hi Denise,

    We’ll probably support small doses of honey in the next version of the book. As in all things that are toxic in high doses, quantity matters. I don’t think there’s much need for sweeteners in a healthy diet, it tastes great without them. The main issue is that we want to keep fructose consumption down.

    Beans need a lot of preparation to detoxify, including overnight soaking plus thorough cooking. Our belief is most people won’t take the time to do this. In any case animal foods are safer sources of protein, and “safe starches” are safer sources of carbs. Beans add diversity to the diet, but they’re not a great food. If you like them and are willing to do the soaking and thorough cooking, then go ahead and include them.

    Best, Paul

  4. Hi Paul,

    I was the gal who had arrythmia to probiotics. I should add I didn’t always have this. It only occurred last Fall after trying GAPS and taking a probiotic with 100 billion cfu’s per capsule for a month. I was told by an MD, trained by Campbell-McBride, that this arrythmia happens sometimes in people on GAPS but that it’s very rare. He advised me to stop taking probiotics and to add in more rice. I’m in the process of getting the metametrix stool test now.

    You mentioned you weren’t familar with the “hosekeeping wave” It is, and I quote from another source because I’m just learning about it, “a strong contraction of the bowel that occurs in between meals. It last 5 to 15 minutes and it cleans the small intestine.” A missing or weak wave seems to be a primary contributor to people with SIBO. I wonder if the benefits of the ketogenic fast for people with bacterial infections aren’t also because of this wave. It happens on an empty stomach.

    Dr Mark Pimentel did a study of patients with SIBO that were given antibiotics until the bactera cleared and then given a very low dose of erythromycin at night on an empty stomach to get the wave functioning again (25 of the 47 who returned had complete normalization). This study was published in the December 2000 issue of The Amercan Journal of Gastroenterology. He has also did a study comparing diet and the antibiotic neomycin to get rid of SIBO. He used vivonex plus, a feeding liquid, for the diet. The diet worked better. I’d be curious to hear your thoughts on this.

  5. Paul,
    I have papillary thyroid cancer and am slated to have my thyroid removed next month. What modifications to PHD would you suggest for someone that has had a total thyroidectomy?

    Thank you,

    Hi Joe,

    Sorry to hear about your cancer. I’m not sure that thyroidectomy leads to any changes, other than that you can be much more aggressive about supplementing iodine; and you should be more careful to make the macronutrients come close to the body’s natural utilization — 30% carbs 15% protein 55% fat and very low omega-6 is good to aim for. Especially PUFA needs to be kept low. The reason is that with reduced ability to adjust thyroid hormone to dispose of excess macronutrients, you need to make sure all of your dietary macronutrients are useful to the body.

    Best, Paul

  6. Re: Migraines in 16-year-old daughter

    First, what a wealth of information in this q & a! I just bought your book a few days ago for my own good, but began wondering about how this could possibly help my daughter who has been suffering from chronic migraine since the age of 4. We have tried everything, and aren’t really crazy about the prophylactic drugs her neurologists have recommended. She is currently on some natural therapies given to her by an alternative healer–Head Q (a Chinese herb), Methyl (because said healer detected metal toxicity), fish oil (because said healer thinks my daughter is anxious/stressed, but who wouldn’t be when you worry about when your next headache will come?) He also has her on some drops I believe called Somatica–for calming effects and another capsule called Laminine. She’s been feeling pretty good with the exception of dizziness/unsteadiness quite often.

    But wouldn’t it be wonderful to help her via diet!?!

    Any thoughts? I so appreciate how you take the time to answer questions. You are a gem!

    Hi Ellyn,

    The things to try first are a non-toxic hypoallergenic diet like ours, supplemental magnesium, and then a ketogenic diet. Read our migraines/headaches category: http://perfecthealthdiet.com/?cat=56.

    Best, Paul

  7. Hello,

    I’m wondering if Paul or anyone else knows about underlying causes of bruxism (teeth grinding)? I am grinding my teeth day and night and cannot stop! I’ve also noticed my 18 month-old doing it now too. I suppose he could be mimicking me, but I have heard anecdotally about a connection between parasites and teeth grinding so I was wondering if there is any validity to that or something else as a cause?


    Hi Nicole,

    I am also suspicious about infections and teeth grinding. I ground my teeth for 10 years and wore a night guard to minimize the damage. Then after I adopted our diet and got rid of my CNS infection with antibiotics, I happened to try taking out the night guard and found that I no longer clenched or ground my teeth. My TMJ disorder had disappeared along with the brain infection.

    That’s not very specific, but I would definitely see if you can get any infections diagnosed.

    Best, Paul

  8. The Bbq sauce i use contains organic cane sugar,which contains 12 grams of sugar per 2 tbsp.Should i use this sparlingy?Or do i need to find a bbq sauce that doesn’t contain sugar?

    Hi Frankie,

    I’m not thrilled with sugary BBQ sauces, especially if they’re going to be cooked on the meat at high temperatures.

    I think a glucose-sugar based BBQ sauce would be better than a sucrose-based one, or you could use it sparingly and perhaps apply it after cooking.

    Best, Paul

  9. Hi Nicole,

    I grind my teeth as well and have been told that it is stress related, so learning to try and reduce and manage stress better. As for your 18month old – that is a harder one. Perhaps something to do with growing teeth?


  10. Hi Paul,

    I wanted to give an update on my quest to find out the source of my dizziness/ataxia/balance issue (not vertigo). I’ve posted about this on other pages and wasn’t sure where to post an update… anyway, I’ll try not to make this too long…

    I still have not discovered the culprit yet… still thinking and searching. So my latest thought is, what if it’s a candida overgrowth (in my brain??) or some other fungal overgrowth? I don’t know how probable that is, but I’m willing to try every avenue and I don’t want to dismiss any ideas because I really want to figure this out so I can fix it! So, aside from making sure my diet is not ketogenic, what else might I do/ not do if I suspect a candida infection/overgrowth?

    I did already rule out the hemochromatosis after getting iron blood workup done last week (ferretin, TIBC, serum iron) and they were all well within normal range.

    As I mentioned before, I was curious if I might have issues with nightshades, so I cut them out completely (I did it only briefly before, prob not long enough) so now my mainstay carb source is rice since cutting out the potatoes. I thought this could be the problem because of the effects that solanine can have on neurons (oh I can’t remember exactly what, but I think I read that the solanine inhibits acetylcholinesterase enzyme, which is needed to break down or recycle acetylcholine. so without the enzyme, you get something like a buildup of acetylcholine which is not good for the neuron… something like that…). Please feel free to correct my ignorant explanation so that I don’t misinform others if I got the terms wrong. I’ve been reading so many different areas lately…

    I went to an ENT last week and he didnt think I had any inner ear problem, especially since I don’t have vertigo. I had bloodwork done again to check for infection when I felt a lot of sinus pressure a few days ago, but nothing looks out of the ordinary on bloodwork. They irrigated my left ear because of a piece of wax which was shamefully large when it finaly came out! But, that was a week ago and my symptom is still there.

    The only other symptom I now notice that I sometimes have is low blood pressure. However, the balance/ ataxia issus does not always coincide with low blood pressure. But overall my bp has been lower than normal for me. One day last week it was 103/58. The 58 scared me a little because for me that is low. It hasnt been that low since, but it’s still usually around 103/66 or something like that. This symptom got me thinking about Vitamin D supplements. I had written a few weeks back where my doctor had prescribed vit D (50,000 IU tablets) for me to take one per week for one month just to get my D levels higher. This theory for causing the ataxia looks possible, but I only started taking those megadoses on Feb 14 (and I actually take one every two weeks because 50,000 sounded so high) and my symptoms started maybe around the beginning of the year (I wasnt paying attention then so I don’t know exactly when it started but that’s my best guess). However, I had been taking 1000-2000 IU Vit D for a couple months before the mega doses so it still could be the vit D supplements… ? OR… of course there’s the possibility that the lower blood pressure and the ataxia are not related. Low bp could in fact be from the high dose vit D and the ataxia could have a completely separate cause. Candida overgrowth perhaps?

    I don’t know if this is related or not but I have had a lot of film in my eyes by the end of the day (mucus?). When I wake up my eyes have a little bit of crusty stuff around edges but not much, but inside my eyes usually has a film again in the morning. Sometimes there is a film on my mouth in the morning and usually on the rim of the water glass I drink from. I had always thought that was from the chapstick I use constantly, but now I’m wondering if it’s fungal??

    Also thinking about heavy metal issues in the brain (I watched a short clip on mercury actually degrading a neurite… amazing and scary!) so… I’m considering having my amalgams replaced and have an appt on Thursday to look into that. Also just went to regular dentist to check for any obvious culprit there (infection?) but everything looks pretty good on xrays (except for a few small areas of minor decay that they will work on tomorrow) –no infection, roots all look healthy and free of infection, etc.

    I still have to check my thyroid levels (TSH was normal on bloodwork at end of Jan. but didnt yet check T3, T4 and rT3, and also didn’t yet find out what all those mean!!) to see if there’s any problem there related to the ataxia.

    Also, will try to get some kind of brain scan done and have my heart checked too… but in the mean time I still want to pursue these other areas…

    Oh well, this sure did end up being long! Sorry about that…

    Anyway, all that to say, any thoughts/ suggestions on my trying the anti-candida route for now?

    Thanks so very much for your time!

  11. Hi Paul!

    Is there already an evaluation or comments about the study about red meat consumption just published by Harvard School of Public Health?

    For me as still kind of new to Paleo, Perfect Health Diet, etc. it sounds quite disturbing.

    Best, Dirk

    Hi Dirk,

    Craig Price asked about it, and I replied here: http://perfecthealthdiet.com/?p=2046#comment-63852. Insofar as it indicts “red meat,” it’s probably only indicting pork, which we discussed in a recent series.

    I might add a another thing: it’s only an observational study, and there are many confounders. In general, people who eat more red meat are more likely to smoke, drink, and refrain from exercise. It is not possible for data analysis to remove confounders.

    I don’t think it’s a reason to change any of our advice. I do think it’s best to be careful with pork consumption.

    Best, Paul

  12. I think this is the study:


    The authors say they reached their conclusions “After multivariate adjustment for major lifestyle and dietary risk factors.” It is further stated that “Men and women with higher intake of red meat were less likely to be physically active and were more likely to be current smokers, to drink alcohol, and to have a higher body mass index (Table 1). In addition, a higher red meat intake was associated with a higher intake of total energy but lower intakes of whole grains, fruits, and vegetables.”

    If I ever get a Pd.D. in statistics I will review this study in further detail. Speaking as a layman, while I have a lot of respect for researchers, I find it tough to believe that every potentially meaningful variable is controlled for.

  13. What do you think of this product to treat Candida?


    I guess I’m concerned that it could wipe out friendly gut flora. I’m going to combine it with a probiotic.

    I still don’t even know if I have candida. I do have a coated tongue though (yellowish), dandruff, and recently I’ve started to get itchy!

    Thanks Paul! PHD is the best!

  14. Just wondering whether bananas can count as a ‘safe starch’ based on the PHD food plate. Other than rice, potato and sweet potato, the other listed safe starches are hard to come by where I live. After being VLC for some time, I am working towards repair some of the metabolic/hormonal damage that has been done and introducing safe starches back into the diet, with the combined objective of losing weight (but recognise need to have a healthy body to lose the about 5kg that has crept on). Thoughts would be appreciated, as want to follow PHD guidelines as close as possible.

    Hi Caroline,

    Bananas are a healthy, PHD-approved food. I’m not sure I’d call them a starch however. They are about 2/3 glucose, 1/3 fructose.

    Best, Paul

  15. Has anyone read ‘Healthy Sexy Happy’ by Nancy Deville? Very similar ideas and thoughts to PHD with the focus on optimal health. There are some differences, mainly relating to legumes, but a believer in eating the carbs just below what the body needs to lose weight and using vegetables for their micronutrient benefit with proteins and fats to build the body. Interesting reading for anyone who is interested in PHD.

  16. Hi Paul,

    I was recently inquiring as to the possibility of a having celiac disease due to various symptoms. LUckily I was able to do genetic testing a while back, and though I’m negative for the main subtype of celiac, hla-dq2.5, I was reading up on certain research articles citing the snp rs7454108 as a tag for the hla-dq8 haplotype. I looked into my genetic data and my genotype for that snp (rs7454108) is CT. Sorry to stretch this question out, but the data indicated that the C allele was associated with DQ-8, does that mean my CT is incompatible with that, or does that mean it indicates DQ-8. Thanks again for any input, it’s greatly appreciated!!

  17. Paul,

    Quick update on my Thyroid situation. I got the actual reference ranges if that makes a difference. I saw my Doc and she was riding the fence on whether or not to start meds. She wasn’t interested in getting antibodies checked, claiming it didn’t effect treatment. But based upon symptoms, numbers, and the fact that the FAA is going to need something that is euthroid, we started Synthroid .25 mcg. I will be switching to your recommended Selenium Complex and sticking with 1g Iodine (via Kelp) per your recommendation not to increase Iodine yet. So I guess we just wait for a month to retest thyroid and adjust dosage. I also purchased the Iodoral Iodine, but not sure about when I should work up to 1/4 tablet? After achieving euthroid labs?


    FT4 .79 .65 – 1.46
    TSH 4.948 .358 – 3.740
    FT3 2.8 2.3 – 4.2

    In other news, and somewhat related I’m sure, I wanted to get your take on the results of an advanced panel I recently received via HDL labs. Blood was drawn about a month after introducing safe starches and only two weeks on PHD supplements. The year prior was VLC Paleo, with weight loss (220 down to 190ish). Many years before that where conventional wisdom nutrition. Only consistent supplements during the VLC period where probiotics and lots of EPA/DHA (ala Robb Wolf). Most of my new results where flagged in Green as “Optimal” except where noted.


    TC 263 Red Flag > 240
    LDL Direct 146 Red Flag >130 (CHD>100)
    HDL 83
    Tri 89
    Non-HDL 180 Red Flag >160


    Apo B 115 Red Flag >80
    LDL-P 2217 Red Flag >1300
    sdLDL 50 Red Flag >30
    Apo A-I 211
    HDL-P 58.8
    HDL2 18
    B:A-I ratio .55
    lp(a) Mass 14
    Lp(a) Cholesterol blank?

    Soooo… of course the doc gave me the “eliminate fat.. Cut way down on sat fat” lecture. My previous labs where pre-Paleo: now my HDL is highest ever, Trig’s are the lowest ever, but LDL is UP. I had requested the advanced panel to ensure that my LDL was NOT small dense, so big surprise to see 50%. Most of the ratios seem good Tri/HDL = 1.1, TC/HDL = 3.2, and HDL/LDL =.6. Which do you think is the most useful? The second section (Lipo Particles and Apo) is new to me, but appears to contain similar good news regarding HDL and ratio. Nonetheless, the LDL, sdLDL and especially the LDL-P seem alarming. So all my HDL stuff is way GREEN and all my LDL stuff is way RED. I have read the two PHD blogs on “Paleo and high LDL” and the blog regarding Thyroid and LDL. So, how concerned would you be with these numbers and would have any other advise besides allowing time for thyroid to normalize, more time for increased carbs to kick in, and more time for the supplements to help. That’s a lot of waiting…..


    Myeloperoxidase 250
    Lap-PLA 190
    Hs-CRP .7
    Fibrinogen 354

    All where flagged as “Optimal” so I’m really happy about that! I had just wanted the CRP, so the other markers are new to me.


    NT-proBNP 25
    Galectin-3 9.6

    Both are new to me, but “Optimal.” Together, my inflammation and myocardial markers would suggest that vascular damage is not an issue, and probably not causative in my LDL crisis (as suggested in your Paleo high LDL blog). Do you think the subclinical hypothyroidism is more of a factor here?


    Aspirin Works blank


    Apolipoprotin E Genotype 3/3


    CYP2C19*2*3 *1/*1
    CYP2C19*17* *1/*1


    Factor V Leiden Arg/ARg
    Prothrombin Mutation G/G
    MTHFR C/T (Yellow Flag 39.8% Genotype Frequency)

    Seems like most of these are tests to see how well you respond to big Pharma? All was Green except the last one which has something to do with Folate metabolism?


    Insulin 8
    Free Fatty Acid .51
    Glucose blank?
    hbA1c blank?
    25-hydro-D 51
    Homocycsteine 12 (Yellow Flag 11-13)

    Don’t know why Glucose and A1C where blank… two of the things I wanted to see most!! Vit D looks to be at high end of your targets. Have been supplementing 4000 D3 for dreary winter and will probably drop back to 3000 D3 and take some more sun for the Spring/Summer. Do you think 2000 would be better? Homocycteine was a bit high I guess… concern?


    Omega 3 Index 6.5 (Yellow Flag 4-8 % range)

    Omega 3 Fats Total 9.5
    ALA 8% EPA+DHA target is geared for SAD’ers with high n_6? All my n-3’s (except for ALA????) where mid to high range, and all my n_6’s where low to mid range. So what’s up with that ALA being off scale low??

    Is there a way to correlate these results to your 2.5 : 1 goal for long n_3 : long n_6? Am I correct that “long” n_3 would be the sum of DPA, EPA and DHA? And on the N_6 side of the ratio, all I have here is AA…. do I need DGLA? Maybe DGLA is insignificant and we just use AA? In that case:

    (DPA+EPA+DHA) : AA …. that puts me at 1:1.6 ouch!

    or is total omega 3 : total omega 6 useful, 1:3.3 and SAD?

    What are the best ways to improve my profile besides continuing to eat 1lb salmon/week, beef/lamb and continuing to avoid all the Franken oils? I’ve really cut back on almonds too. Will my profile correct some as I hopefully start reducing from about 24% body fat towards the low teens? Lastly, is the 43.8% Saturated anything to be alarmed about?

    Thanks again for all you’re help and sorry for being long winded, but I figured it’s better to provide too much information than not enough. Perhaps a blog about “PHD labs and markers: how to interpret your lab work and what to strive for?” would be useful in the future?


  18. Dirk

    Hi Paul!

    Is there already an evaluation or comments about the study about red meat consumption just published by Harvard School of Public Health?

    For me as still kind of new to Paleo, Perfect Health Diet, etc. it sounds quite disturbing.

    Best, Dirk

    FYI….. Denise Minger took some of the teeth out of the hype in her traditional style:


  19. Hi all,

    I am currently taking prednisolone (corticosteriods) for my ulcerative colitis. I have heard that taking this can increase blood glucose levels.

    I don’t really understand much about blood glucose but was wondering if this should affect how many carb calories I aim for.

    For instance, i’m currently aiming for around 500 – 600 a day from dextrose powder, juiced berries and banana. Should I be cutting back a bit if my blood glucose levels are being elevated by the medication?



  20. Hi Paul,

    I too found your blog quite by accident and am very thankful that I did. Been reading the book on my Nook tablet and think I will have to get the print version. I am having a hard time understanding everything in the book – science was never my best subject. 🙂 My husband is a food chemist so I’m hoping he will read the book and help me understand better!

    I am 55 yrs old, post-menopausal, and frustrated with where my health is right now. Been working with different naturopathic doctors to figure out what’s going on. Currently working with one who uses Computerized Bio-resonance Screening (CBRS) to find imbalances. He found Lyme’s & Candida. Worked with a LLMD also and was on antibiotics for 7 months. Lyme is under control but can’t seem to get rid of candida. Naturopath says it is not affecting long term health, but then why do I struggle with the symptoms? Here are current symptoms: brain fog (comes & goes), cognitive issues, memory loss (sometimes I can’t remember what I ate or did the day before), chocolate & sugar cravings, gas, bloating, abdominal discomfort, constipation (if I forget to take supplements),sleep problems, scratchy eyes, joint pain in hands, numbness in hands & fingers at night, slow weight gain, yeast infections, lack of energy, skin rashes. I’ve pretty much cut out wheat for the past 4 years and recently all grains, am working on getting rid of bad oils, don’t eat alot of processed sugar but do bake with almond meal, agave, and honey. Am trying to eat paleo and have added white rice, potatoes, and sweet potatoes. Current supplements are: MSM (4000 mg daily), ParaMicrodicin 250 [grapefruit seed extract] (8 daily 5 days, 2 days off) Enzymatic Therapy Pearls (3 daily), Vitamin D (3000 IU), Natural Calm magnesium ( 1 Tbsp in evening), Garden of Life Perfect Food (1 scoop daily), Nature’s Plus Source of Life Gold energy shake (1/2 scoop daily).

    I was attracted to your diet (I would call it a lifestyle!) because you said that you had cognitive issues that you cleared up. I would love to have my memory back! Was going to try a ketogenic type fast or diet but then I came across your comments on another site that that would be the worst thing to do for candida. So…am at a loss as to how to best help myself.

    Thanks in advance for any insights you might have!

  21. Hey Paul,

    What do you think about this harvard study linking white rice to diabetes?



    Hi Richard,

    I think it’s one of the most twisted paper analyses I’ve seen. They don’t even try to discover why diabetes rates are so much lower in Asia than the west, despite much higher rice consumption. The in-country dependence in Asia is probably a diagnostic effect – since diabetes is diagnosed based on a specific fasting blood glucose level, eg 120 mg/dl, and fasting blood glucose in diabetics/pre-diabetics rises with increasing carb consumption, and rice is the primary carb in Asia, the in-country dependence in Asia doesn’t reflect any difference in health, but a difference in diagnosis due to higher carb consumption.

    Best, Paul

  22. Hi Paul,

    I’m so disappointed in myself for not recognizing that my vitamin D levels have been falling. In 2009, my vit D measured 55 ng/ml and now my most recent result is 28 ng/ml. In this time period two auto-immune diseases have surfaced for me. Arrrgh!

    I’m really not consistent on taking my vitamin D supplement, though since I’ve started to read this blog I’m getting better at it. I’d say on average right now I take 6/7,000 units three times a week

    Can you give me a suggestion as to dose/time period that might be optimal to raise my levels? I’m thinking 10,000/day for three months and get tested again.

    Thanks for what you do here!

    Hi HM,

    As a rule of thumb, 4,000 IU/day is plenty. That’s 28,000 IU/week. You’re now on 18,000-21,000 which would be OK if you get sun exposure on bare skin. I’m guessing you’re from a northerly latitude and don’t.

    If you’re deficient it’s probably a good idea to take an excess for a few weeks and then go back to your best shot at a long-term dose. So maybe 10,000 IU/day for 2 weeks, then 4,000 IU/day, tapering down toward 2,000 IU as you start getting more summer sun, then back up to 4,000 IU/day when next winter rolls around.

    But the best way is to test regularly and figure out how to keep serum 25OHD steady in the 40-45 ng/ml range. (100-115 nmol/l).

    Best, Paul

  23. Andrea Whitmore

    Hi Paul,

    Thank you so much for your book and generosity with you time and in sharing information here. I have a couple of questions for you: I will soon be starting the protocol for treating yeast and SIBO (with antibiotics and an antifungal) and diet. I’m wondering if the 200 calories of safe starches per day will interfere with the yeast and bacterial die-off or if it’s okay to include them because I’ll be taking perscribed medicine along with the PHD. Or, should I stop all starches until I’m completely through the die-off stage?

    Second question: I have numerous food and some environmental allergies that came up on and IGg and IGe test, dust mites being one of them, and I’m wondering if perhaps many or most of these will clear up after I address the chronic infections in my gut?

    Thanks again,


    Hi Andrea,

    I think you should get at least 200 calories of carbs per day, maybe 400-600, but it doesn’t have to be from starches. Often simple sugars are better in bowel infections, they are absorbed more easily and leave less food for microbes in the gut. Dextrose, rice syrup, honey are all possible choices.

    You can experiment with different carb sources and find what works best for you. Starches are good when you have healthy gut flora, but not necessarily when you don’t.

    Best, Paul

  24. Paul, there is a really interesting article in Harper’s this month about fasting, and the author fasted for 3-4 weeks with great results. Unfortunately, you will have to buy the magazine issue, or subscribe if you want to read it (I copied the article at my local library), but I wonder what you feel about “extended” fasts.

    Her si the link:

    Hi David,

    Thanks, I wish I could read the article! In general I favor less arduous fasts, I think you can get the same benefits with less risk from more frequent but less arduous fasts. However, there have been certainly been cases of people benefiting from long fasts.

    Best, Paul

  25. Hi Paul,

    I was wondering if there was any daily meal plans available for the PHD? Am reading the book and find it fascinating. I’m just having a hard time to get everything in proportion and looking for something to base my meal plans off?

    Hi Ali,

    We’re working on meal plans, but they’re not available yet. We do however have some meal ideas, click the “Food” category for those.

    Best, Paul

  26. Paul & Shou-Ching…what do you think of this product from Life Enhancement that purports to help you “eat like a caveman”? It’s potassium bicarbonate in pill form:


    The argument is that our current diets are slanted pathologically to the acid end, and lacking in potassium, so I suppose it’s not a bad thing to try, if you can’t change your diet as you 2 have urged us. But is there any downside to popping one of these pills after each meal? (I tried taking them on an empty stomach, and it hurt!)

    Hi David,

    It’s not necessary on a healthy diet. Plant foods / vegetables will supply potassium, and bone broth and salt and vegetables and a magnesium supplement and water and mineral-rich diet will provide enough electrolytes and buffers to allow the kidneys to regulate pH.

    I know some weightlifters / bodybuilders have used potassium bicarbonate to promote muscle synthesis; see Prof Dr Andro’s Suppversity for that. But it would be expensive to do that with small pills. Powdered forms from the supermarket would be cheaper.

    There are potential acute effects, as you’ve experienced, so I would recommend food. Potatoes, tomatoes, and bananas are good sources of potassium.

    Best, Paul

  27. Paul,

    I got a friend to finally buy your book and he’s going to do the PHD diet. He has been really thin and claims not to be able to gain weight for about a decade now. This is a guy who played college baseball and was the picture of health, huge muscles, low body fat (8%). He finally sent a list of his symptoms. Could you take a look and maybe suggest adjustments to the PHD (high/lower range carb or protein, supplements different than standard recommendations) and possible things to check out like infection maybe? Thanks.

    From his email:
    “Here is a list of some of my syptoms:

    -Heart palpitation pretty much all the time.
    -Constipation and bloating (Inconstancy)
    -Cold hands after meals
    -Waking up with rapid heart rate at night sometimes.
    -Low exercise tolerance (Low energy)
    -Low body weight(Inability to gain weight)”

    Hi Jay,

    I would start him on the diet, vitamin D (sun is best, supplements too if he can’t get sun, but he should be able to get sun exposure in Texas) and magnesium right away and get a stool test. The heart palpitation could be some nutrient deficiency eg magnesium or circulating toxins or infection, but best to get on the diet for a bit and see what happens. The stool test might turn up an infectious origin for some of these symptoms. Low energy is just immune activity, presumably from the same cause as the bloating.

    Best, Paul

  28. Dear Paul and Shou-Ching,

    What a wonderful gem of a book you have written!

    On my 3rd or 4th reading. Beautifully written. A masterpiece of simplicity and pedagogy. Brilliant idea to essentially summarize everything up front.

    Have recommended it to many of my family and friends.

    Quick question: any opinion on pumpernickel, say, Westphalian Pumpernickel (which is wheat free)? Good to eat? Risky?

    Best wishes and continued good success,


    Hi Andy,

    Rye, which is the grain pumpernickel is made from, contains gluten and is not safe. However, it is better than wheat. In a lot of studies rye does much better than wheat. I mentioned one in this post: http://perfecthealthdiet.com/?p=1963. Expand the picture of the fat cells, the rye fed mice were much healthier.

    So, you have to decide whether your pleasure in pumpernickel is worth the risks. We personally don’t eat it.

    Best, Paul

  29. Hi Paul,

    Do you have any suggestions for how to treat petechiae? I have been developing them at a noticeable pace these days. They’re not clustered but seem to show up randomly in various locations on my body. I was wondering if your collagen support suggestions (broth, vit C, others?) would apply to blood vessels. Am I even thinking in the right direction?

    Thoughts on causes would be appreciated. I’m at a loss and my doctor dismissed it as a sign of my “getting old.” (I was 30 when I asked him.)

    My sincerest thanks.

    Hi Sara,

    When your doctor said he was going to become a comedian, everyone laughed. Well, they’re not laughing now!

    Sorry, just an aside.

    Petechiae is a hard symptom to diagnose because its very non-specific and can have many causes. The most common causes (http://www.mayoclinic.com/health/petechiae/MY01104/DSECTION=causes) seem to be (a combination of) circulating toxins, usually from infections, and deficiencies in nutrients for the extracellular matrix around blood vessels.

    I would experiment with several steps:
    1. Bone broth, collagen/gelatin, vitamin K, vitamin C. Green leafy vegetables might also help.
    2. Detox aids — water/broth, salt, potassium-rich vegetables such as tomatoes and potatoes for hydration and kidney excretion; bentonite clay or activated charcoal for fecal excretion; sweating (either by exercise or sauna) for sweat excretion.
    3. If you have any evidence of infection, seek diagnosis and treatment. An example could be a stool test.
    4. Finally, try stopping supplementation for a while (1 month) to make sure you’re not getting toxic doses of anything. Selenium is most likely to be at fault among the PHD supplements.

    Best, Paul

  30. Dear Paul,
    just a quick question: what would you recommend for an underweight person (51kg/176cm) who has psoriasis, constipation and low energy and libido? (incidentally, I also had occasional migraines that have gone away since I have eliminated gluten from my diet a few months ago). Your feedback would be much appreciated!
    Best, M

    Hi Mark,

    First I’d recommend a stool test. Constipation, psoriasis, low energy and libido could all be symptoms of some kind of parasitic gut infection.

    Also, implement our diet to try to remove any food-related causes of trouble.

    Best, Paul

  31. I second the petechiae question. I have these little red dots since teenage (65 now). Why are you opposed to unpasturized vinegar? How is that different from fermented vegetables ?

    Hi Anita,

    I think I only voiced concern about unpasteurized vinegar in the context of people with ongoing fungal infections. For healthy people it should be fine.

    Best, Paul

  32. Paul

    I noticed that you are attending conferences with other leaders in human health. To me conferencing means communication and at least the intent to advance the science despite differences. My question revolves around helping us average end users understand the science and having a conference publish agreed upon ideas. For instance having a common language of scale of effect. Example Is supermarket beef fat really that different than grass fed fat for the average end user to worry about?

    Your book and plan continue to help me every day but often the knowledge is diluted and marketers or others push agendas. Thank You

    Hi G,

    It’s difficult to build a consensus on many of these matters, because the evidence isn’t sufficient. We do try to cooperate with others and to communicate what we believe is true, but sifting of evidence is very time consuming and we certainly don’t have all the answers. We all just have to do our best to find the truth.

    Best, Paul

  33. Thanks for the petechiae info, Paul. Will try your suggestions and report back. Wonder if they might resorb and disappear? Hmm…

    Uh, by the way, I was highly entertained by your humor in the Paleo FX recap post. Laughed out loud at several parts. Your self-described phlegmatic personality + scary smarts + wry observational humor = score one for me, your humble reader.

    Thanks Sara!

  34. hi Paul, was just reading the section on the importance of copper and vascular repair. do you think that it is possible for the body to repair something like a congenital aortic aneurysm and the subsequent aortic valve damage that results from this condition? should i expect my LDL levels to be high as a response to the amount of damage in the aorta and aortic valve as a result?

    am following the phd but plan to up my copper intakes as the only current source of copper is from calves liver.

    thanks, james ardagna.

    Hi James,

    I do believe that the body has great healing powers if well nourished, but I don’t know what healing rates are like from aortic aneurysms. I would definitely recommend vitamin C, bone broth, collagen/gelatin from cooking ox hooves and chicken feet into soups, and general good nourishment including moderate amounts of zinc, copper, iodine, magnesium, and vitamins D/A/K2.

    Calf liver has a lot of copper, so if you eat 1/4 pound of that a week you shouldn’t supplement copper. Some is important, too much is dangerous.

    I wouldn’t expect an old injury to result in substantial elevation of LDL, no.

    Best, Paul

  35. Hi Paul and Shou-Ching

    Awesome book, amazing work you’re doing. If it were possible to win a Nobel prize for literature review and pulling everything together into a coherent paradigm then I think you guys would be a shoe-in 🙂 I particularly love your fresh-thinking, agenda-free approach. Truly disinterested scientific enquiry at its finest.

    Three Qs…

    1. Do you count the short chain fats of coconut oil, etc., as SaFAs? Do they contribute to that fraction of the diet?

    2. Are your plateau ranges for carbs and protein based on a 180lb person, and would thus be adjusted proportionally for larger or smaller people?

    3. How about a post on dairy? As you know this is a controversial topic in the paleosphere and it’d be great to get your more detailed thoughts. How much casein is there in cream and other milk products? Is casein really toxic? What quantity of cow hormones gets into butter, yoghurt, etc? Besides the upsides of all the lovely SaFAs and the great taste, are there any down sides? I am LOVING eating lots of cheeses and loads of cream for first time since I went paleo about 5 months ago, but I do find myself wondering about these things at times.

    Many thanks, and please know what an amazing service you are providing.



    Hi Kevin,

    1. They are SaFAs, but they act very differently upon the body than the long-chain SaFAs, that is why they get a separate chapter in the book, and the long-chain SaFAs are discussed with the MUFAs.

    2. There is an adjustment for body size but it is a little less than proportional to body size. The quantities we recommend are healthy for both men and women, 100-200 lb body sizes. You could scale them up or down somewhat with size.

    3. Dairy is discussed in the book and a bit on the blog. It is an extremely complex food, intended to be biologically active, and so it is not easy to understand its effects. In general, people with healthy guts do fine on dairy but people wiht damaged guts may not; and dairy fats are extremely healthy but problems come, if they do, from the protein and small molecule components. If there is a problem for healthy people from dairy, it will most likely be from the hormonal content. I would eat dairy in moderation, don’t make it a staple of your diet.

    Best, Paul

  36. Hey there Paul,

    I’ve recently purchased your book and am currently mid-way through reading it, what a wealth of information, I really appreciate the scientific take you guys brought to the paleo field.

    I have a quick question:

    I am currently following a ketogenic-paleo type diet (carbs up to 50g). I have noticed that when I introduce some the better fats like organic butter and coconut oil, I start having seborrheic dermatitis like symptoms appearing between my eyebrows (dry, scaling skin). I also typically have a more cloudy/foggy mind and tend to have considerable memory loss. This also happens to me while I eat organic fatty meat cuts (lamb, beef etc). However, when I switch to leaner cuts of meat (non organic from the butcher) and supplement with fats like macadamia oil in particular, the seborrheic dermatitis tends to go away, my brain feels much sharper (almost like it’s been turned on/stimulated) and my memory quickly improves. I would extremely appreciate if you could help me with the following:

    1. Would increasing my carb intake as per PHD might have any positive contribution here?

    2. Would you have any idea what the problem here is? All the good types of fats seem to spark either a negative response or a detox-like response (though I’ve stayed on the ‘good fats’for 4-5 months and the symptoms persisted until I switched to the leaner meat and mac. oil and things quickly imporved).

    The time spent writing this wonderful book and contributing to the community is vastly appreciated.

    Thank you,


    Hi Jason,

    I answered this here: http://perfecthealthdiet.com/?p=5463#comment-68090.

    Best, Paul

  37. My brother surprised us with a diagnosis of testicular cancer. Within a couple days he was rushed into surgery and lab work says it was a late stage 1 tumor (1S). Now comes the decision about follow up. 80% chance it will never return without any more treatment, but 95% chance it won’t return with one dose of carboplatin now. But if he opts for no treatment now and it comes back it would be 3 months of cisplatin, which will knock him out of any other activity for the duration of the treatment. Then side effects ???

    Wife has family history of cancer and she figures if diet had anything to do with cancer she would be the sick one, as she eats more foods like sugar than my brother. My brother is asking for advice and I don’t know what to say, except to offer advice about reading your book and improving their diet. But the fact is, I don’t have any idea if their poor diet had anything to do with this. Our mother says she was not told of a problem with the testicles dropping.

    Do you have any comments about any of this? The chemo meds? How dangerous they might be? (I can’t find much; these seem to be the standard fare for this type of cancer.) The food connection? I did do a search of your site but found nothing. Since you are always searching I thought I would ask if you know anything from recent articles you’ve read. I am very frightened for my wonderful brother.

    Thank you for your time, Paul. I have been following your plan for several months now and am noticing improvements in my physical comfort and my emotional well-being. Thank you for this work you do. But most of my family thinks me nuts.

    Hi Pam,

    My sympathies for your brother.

    I would send him links to our two most apposite cancer posts, http://perfecthealthdiet.com/?p=4739 and http://perfecthealthdiet.com/?p=4637.

    Some important things: Low omega-6 diet; low-fructose diet; plant-food rich diet with PHD macro ratios (~30% carb 15% protein 55% fat nearly all saturated or monounsaturated); vitamins D, A, and K2; selenium, iodine, and magnesium; bone broth, collagen (eg from ox hoof or chicken feet soups), and moderate vitamin C when he is not being treated; circadian rhythm therapies: sun exposure during the day, nature exposure, faces therapy, sleep in totally darkened room, perhaps take time-release melatonin as a sleep aid; exercise but not to exhaustion, mixed with rest; yoga, breathing exercises, relaxation; intermittent fasting, especially during chemo.

    I don’t wish to get involved in discussing cancer treatments, or other medical treatments; doctors are better trained and positioned to judge such things. But I recommend fasting and stopping supplements during chemo.

    Best, Paul

  38. Ah, and what about colonic irrigation? Good for the gut flora to have a clear-out, or baaaaad idea?


    Hi Kevin,

    It will alter the gut flora, so if you have good flora it will be bad and if you have bad flora it will be good.

    Best, Paul

  39. Oh, I’m so glad to hear that about colonics! I recently got my first 2, and they made me feel SO much better. I can eat a little white rice now, without getting all bloated. If you’ve had past digestive problems, especially constipation, its amazing what can get stuck in there…no wonder my abdomen was always bloated and felt terrible!
    Check out Kristina Amelong’s book and website for more info on a PHD type diet, and colon hydrotherapy.
    I think her book “10 days to Optimal Health” and the “Perfect Health Diet” are my top two favorite health books!

  40. Is it important to eat starches with every meal, or can you achieve your 20-30 percent starch for the day at a single meal? Thank you for your help!

    Hi Anon,

    I think it’s best to spread them over several meals.

    Best, Paul

  41. Can you comment on anemia? I have been eating a PHD for more than a year, with plenty of red meat and iron-rich vegetables, yet I have low RBC, low HCT, and high MCV. Do you have any ideas of causes or treatments for anemia? I haven’t been able to find any information on this at the site. Thank you very much for your research and your advice.

  42. christian from France

    Dear Paul and Shou Ching

    Thank you for your book which I bought three months ago. The results are already here.
    But ..

    I suffer from severe sciatica and neck pain due to arthritis.Do you know of any supplements I could take ? would doxycicline be an option ?
    Thanks a lot for everything


  43. Thank you for your reply to my question about my brother. Can you suggest the time line for fasting prior to the beginning of chemo? A number of hours or days? How long after the treatment would he break the fast? As I understand your remarks on fasting, he could have vegetables, bone broth, coconut oil, and heavy cream during the fast. Is this correct?

    Hi Pam,

    The precise timing is not well researched. In the study reported here, http://www.sciencedaily.com/releases/2012/02/120208152254.htm, an arrangement that worked well was to fast 2 days before chemo through 1 day after. This was in mice.

    Yes, during the fast he should eat vegetables in bone broth, salt, coconut milk. I wouldn’t recommend the cream, but if he doesn’t like coconut milk and is hungry that could be used.

    Best, Paul

  44. Hi Paul and Shou Ching

    I have a question about Fish and Omega 3 suppliments, would you recommend taking Omega 3 if I don’t eat fish of any kind ?

    I simply cannot force myself to eat fish at all, I also do not eat any cocnut products

    Any recommendations would be helpful



  45. Hi Paul,

    A few weeks ago I tried your kimchi recipe. I ate it, and the next day I was really itchy. THEY COULD BE UNRELATED, but they could not be…(perhaps I screwed it up and poisoned myself?)

    I’ve been itchy ever since, and I really don’t know why. Head, ears, arms, shoulders…

    I also have dandruff. That’s been a long-standing issue.

    Do you have any ideas? The kimchi guess is a long-shot…I’m sure there’s a larger cause.


  46. Hi,

    I just read this on Dr. Mercola’s site http://articles.mercola.com/sites/articles/archive/2012/04/02/toxic-parabens-on-breast-cancer-patients.aspx?e_cid=20120402_DNL_art_1

    It’s about metalloestrogens – cancer causing ingredients in food supplements. These metals have “estrogen mimicking components” One of them is selenite. It states that Sodium selenite is the primary source of supplemental selenium. Does this cause you to rethink your recommendation for supplemental selenium? Copper and chromium are also included on the list.

    Hi Cathy,

    I am working on a revision of our supplement recommendations. I do think it’s desirable to avoid sodium selenite and other inorganic forms of selenium and to supplement selenium only as organic forms (eg from yeast, plants, or animal sources). Good food sources are kidneys and Brazil nuts.

    The trouble with selenite is one of the reasons we’re leaning toward avoiding multivitamins, which often have cheaper forms like selenite.

    Best, Paul

  47. Paul, is sodium selenite the same as sodium selenate (the ingredient found in LEF Super Selenium Complex)? There may be other inorganic forms of Se in that supplement.

    If so, does this mean you recommend not taking the LEF supplement when doing an iodine protocol?

    Would eating food sources of selenium or taking a yeast-derived selenium supplement suffice during the iodine protocol?

    Thanks for your help.

  48. Hi everyone,

    Someone here asked about meal plans and I just wanted to let you all know that I offer weekly grain-free, dairy-free meal plans. They are not exactly written to Perfect Health, but all you would need to do is add your safe starches. You can check it out here: http://www.naturalhealthathome.com/wholefoodmealplans. Scroll down past the gluten-free option and you’ll find it there.

    Hope it’s ok to post here!

  49. Paul, have you researched (or even heard of) PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections? I’m almost certain I had this as a child, completely undiagnosed, but I’m a medical student now and am so sure this is something I went through when I was younger.

    Anyway, I wonder how it really works, what the long term health consequences are, and if there is a solution under the PHD paradigm. I’ve always has some serious anxiety, as a child but certainly now (but I’ve never sought medical treatment), so maybe I’m just the type of person that’s more susceptible to an OCD “flare” response to the many strep pharyngitis infections I had. Anyway, thought it was interesting to share, given your series on infections and neuro/psych symptoms.

  50. Hi Paul,

    I know this is the Q& A sector of your site, and I don’t mean to rattle the cages, but after scanning through the list of symptoms presented through these 100 or so pages (i estimate) it seems that so many of these problems can be tied to desensitization brought on by something described best at yourbrainonporn.com

    I know it may be “outrageous” or whatever to suggest, but If there is even the slightest possibility of such a confounding variable causing such problems, isn’t it worth looking into?

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