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. Question: Bone broth is recommended, and the time-intensive way to make it is on your site. Is simply buying the common canned broth or cooking stock at the supermarket not nearly as beneficial?

    • Hi Dusty,

      I have no idea what’s in the supermarket cans. I think home cooking is the best way. It doesn’t require attention, just add water and simmer.

    • Hi Dusty,

      I don’t know what’s in the supermarket cans either, but I know what isn’t: flavor. Broth/stock is deservedly a significant portion of the cooking school curriculum.

      I’ve been making delicious broth in the pressure cooker. Takes about an hour and works just as well with frozen meat (the more connective tissue the better); aromatics help but aren’t essential. Only caveat, and maybe a damning one, is I’m cooking in stainless steel rather than PHD-recommended clay. Might look into enameled pressure cookers at some point.

      • @Shawn –

        Does your broth gel? I recently bought a pressure cooker and have made chicken broth with backs and feet and was disappointed that it didn’t gel. Haven’t tried beef stock yet.

        • Hi Betsy,

          Pressure cookers raise the temperature, but for collagen to disintegrate into a gel probably requires time more than heat. Especially if it’s coming from bone, which has to demineralize first. If you add a bit of acid (vinegar) it may happen faster, but a slow cooker might be a better approach to broth.

        • Betsy,

          The slow cooker will take a long time to get the collagen up to melting temperature. I’d love to hear your results of a pressure cooker versus slow cooker broth-off. I might even do it myself. I have a slow cooker in the closet but despite considerable effort never found any dishes I liked.

          I think the key with broth is lots of cheap connective tissue: chicken or turkey, wings, drumsticks, and leg quarters are great. The meat has to be cooked way past edible.

      • Because I’m very lazy, I’ve been using prepared beef and chicken broth instead making it myself. In my naivete, I never thought to check the ingredients, but this string made me actually look at the labels of the stocks I had on hand and did I get a shock!

        College Inn Chicken and Beef Broth each say soy, wheat added under the list of ingredients!!!!

        Pregresso Brand chicken broth lists sugar among the ingredients (I didn’t have beef on hand).

        The other brand in my cupboard is Publix brand Chicken Broth ingredients are: chicken stock, contains less than 1% of: salt, yeast extract, dextrose, onion powder, clery juice concentrate, carrot juice concentrate, onion juice concentrate, natural flavoring (I love that one :cool:), beta carotene (for color).

        Moral of the story: Always check ingredients before assuming they’re okay.

      • Because I’m very lazy, I’ve been using prepared broths and stocks, but reading this string moved me to look at the labels on the stuff in my cupboard.

        College Inn chicken and beef stock both say soy, wheat added at the bottom on the ingredient list. Progresso brand chicken stock lists sugar as an ingredient.

        The Publix store brand chicken stock seems free of verboten additives. I actually find most of their store brands to be very good.

        • I’d google that yeast extract….

          • Monte,

            I wondered about that and googling hasn’t clarified it.

            Can you explain it to me in non-scientific language?

            BTW – Sorry for the double comment.

          • Yeast extract is bad. It’s a source of free glutamate or MSG. MSG is an excitotoxin. Just like the name implies an excitotoxin over stimulates certain nerves in the brain eventually making that receptor numb or dead.

            It’s added because it causes addiction like behaviour (reward seeking) for the “food”. A little wouldn’t hurt as glutamate is found in a lot of natural foods. The amount added to industrial foods though is cause for alarm. Especially if you consider the cumulative effect over time.

            You can find plenty of all natural broths at any health food store. 🙂

  2. Betsy–Yes, sure does. But I’ve been using drumsticks, which I’ve found frozen for 75 cents a lb. I fill my cooker to the max line, maybe about 8 cups of water to 3 lbs. of meat (45 minutes then slow release).

    I’ve tried stock with beef shanks and to my surprise had less gel than I did with drumsticks. I’m going to try oxtails soon, maybe they’ll be better.

    But then again, I’m pretty happy with chicken broth, which I find more versatile. And since I’m skimming the fat I’m unconcerned with the higher PUFA content as compared to ruminants.

    The most gelatinous and therefore best broth I’ve had, by far, was the unplanned remnant of braised lamb shanks, yum!

  3. I’ve been experiencing heartburn when I drink broth, more so with beef than chicken. Any chance that pastured chickens have a better fat profile?

    It’s too bad because I can access ‘healthy’ beef bones more readily than chicken.

  4. Paul,

    Great news to report with my wife’s lipid panel: Cholesterol 238, Triglycerides 78, HDL 112, LDL 110, VLDL 16.

    With her cholesterol increasing 50 points since starting PHD, her Tri/HDL ratio has improved from 1.4 to 0.7 and VLDL has gone down!

    (Probably also more evidence that I have infections to address: wife and I eat very similar diet and my LDL is twice hers.)

  5. I’m wondering if you would discuss the benefits of mineral water. In the book you briefly mention that it is an alternative to taking supplements for some minerals such as magnesium. I know there are many varieties of mineral water, but what would be a ballpark recommendation for how much to drink per week if I want to avoid taking a magnesium supplement?

  6. Hi, Paul. After I take some vitamins, my heart races. It’s happened just with 1000 mg of vitamin C. Could that be candida die-off? (I test high for candida antibodies).

  7. Hi Paul, I was following the PHD last year and felt great, but decided to give the GAPS diet a go this year to deal with some food intolerances. I know you’ve written about the downsides of low-carb for some people and I’ve had a couple of side effects from GAPS that I can’t find information about anywhere. The first is that my menstrual cycle has been totally messed up. I have a period only every 2nd month, if that. The second is that if I have a cut on my finger, even a paper cut, it takes 2 weeks or more to heal and gets infected. Any thoughts on these issues would be greatly appreciated 🙂

    • Hi Angela,

      It sounds like you are eating too few carbs. GAPS doesn’t need to be very low-carb. So you might look for GAPS-supported carbs that you can eat more of.

      Also, you are probably vitamin C deficient. Scurvy was one of my “zero-carb dangers.” Try taking vitamin C to something close to bowel tolerance (stop if you feel the slightest bit queasy).

      I think those two changes should help a lot.

  8. Hi Paul,

    Thanks so much for the help that you have been in the past. I have yet to have my cholesterol re-tested but am confident that there will be big improvements since implementing your recommendations.

    My main problem now is h.pylori. After initially showing up in a blood test I was treated with antibiotics in November last year. My symptoms seemed to subside somewhat but then returned and I had a breath test to see if the eradication had worked. The breath test showed up negative. So I decided to go down the metametrix stool test to see if there were other pathogens causing my problems. The metametrix test came back positive for h.pylori which makes a lot of sense. I follow a very low fibre diet as it improves my symptoms significantly, maybe this contributed to the false negative on the breath test as it lowered the population of h.pylori?

    I had the metametrix test through a naturopath as my doctor did not want to register with the lab that handles it in Australia (I think she felt out of her depth). The naturopath wants to treat the infection with botanicals. I went back to the doctor and she wrote me a prescription for another set of antibiotics.

    I don’t know which path is best. From what I’ve read of the initial antibiotic treatment doesn’t work then it can be very difficult to dislodge with further treatments. I’m also skeptical of the botanical approach as if a powerful drug can’t get rid of my particular strain then I suspect the natural approach has even less chance of success.

    At the moment I’m feeling very depressed about this as I’m certain the h.pylori is the behind of all of my digestive issues and multiple food sensitivities. I desperately want to get on the path of healing the gut.

    Paul, I would really appreciate your opinion on the best path forward for me here.



    • Hi Adam,

      I’m afraid I don’t know the best course, and neither do doctors. Everyone can have an opinion but patients differ and there’s no telling whether what works in one will by best for the next.

      So I think you have to form your own judgment, try an approach and measure whether it worked.

    • Adam,

      Like Paul, I have no idea what will be helpful in your specific case, but for what it is worth, my feeling is that you may be underestimating the power of the botanical approach. One regularly hears cases of people with serious diseases using botanicals with success, not simply as a “gentler” alternative to antibiotic drugs, but where antibiotics have failed.

      (Some herbs are so potent that one must take the same precautions against destroying beneficial flora as with antibiotic drugs.)

    • Hi Paul and MM,

      Thank you both very much for your replies. I have little confidence in my doctor or the antibiotics at this stage so I think I will give the botanicals a go. At the least they should help with the symptoms and in the meantime more studies may come up with the best eradication method.

      Thanks again,


  9. Hi Paul,

    I like the new website look!

    I have 2 questions:
    Do you know if it is safe to take lithium orotate on a long term basis? It’s helping me with anxiety and depression and I’d like to feel ok about continuing to take it in place of Prozac, which I’ve successfully gotten off of.

    Secondly, do you know if Monolaurin supplements are effective against bacterial infections in the gut and brain?

    Thank you!

    • Lithium has downsides. It alters immune function and can promote eg acne.

      At very low doses, 2 mg or less, it’s clearly good, but at the doses used to relieve anxiety and depression it will have side effects. Whether it’s worth it, you have to judge.

      Monolaurin is probably most useful against enveloped viruses, but it might have some value against bacteria, although it will be a very expensive antibiotic. I’m not aware that it penetrates the brain.

  10. I am writing on behalf of my sister

    she is 57years old , and she has osteoporosis,but the main problem with her she feels severe cold all the time she wears thermals ,socks and our country in united arab emirates is a warm sunny weather nearly the whole year, please can you advice her,(she checks thyroid often) she has done many test but the doctors couldn’t define her illness.

    • Hi alya,

      Feeling cold is usually due to hypothyroidism, but you say the doctors do thyroid tests and can’t diagnose a problem?

      If the doctors can’t diagnose it then it’s unlikely I’ll be able to.

      I would just make sure she is not selenium or iodine deficient by eating foods like shellfish and kidney, and maybe supplementing iodine. Also, supplement magnesium to support energy production, and vitamin C.

  11. Monte,

    Thanks for the information about yeast extract. It was simple enough even for a science drop out like me to understand. I’ll check out broth at the health food store because I use a lot of it.

  12. Congratulations on your upcoming book. I am a long time follower of your blog and have benefitted from your insights. Have held back on a question regarding berberine since you have indicated you might do a post on TCM. Now that it looks like that post may be awhile in coming…… I wonder if you have time (heh) if you could comment on it as a supplement for cholesterol & fungal infections.
    Thanks and can’t wait for the cookbook.

  13. 😛 I really enjoyed the interview with Dr. Mercola. I am a student of nursing with my goal to practice as an ARNP. I am a firm believer in diet heals all or almost, And I will continue to be a student of nutrition following your work. Angel

  14. A friend of mine is suffering from multiple problems and his life style does not help i.e. smoking and alcohol. the main problems are prostate and diverticulitis. Please help me explain to him in layman’s terms how to help himself. I am also recommending your book. angel

  15. BROTH – we’ve tried various recipes for making broth and different methods – slow cooker, pressure cooker, oven, casserole on top. We’ve found that the best recipe is also the simplest and always produces a jelly, although sometimes it takes a day or so in the fridge to set. The slow cooker is, IMO, far better than the pressure cooker, which I think denatures the food. Recipe: bring to the boil a couple of litres of water, the bones, an entire head of garlic (ie many cloves), crushed, 2tbsps acid (cider vinegar or lemon juice) and some sea salt. As soon as the liquid is boiling, transfer to a pre-heated slow cooker set to Low. An alternative is to put the cold ingredients straight into the slow-cooker set to High and turn it to Low when it reaches boiling. Leave for 24 hours, strain and cool. We skim off the fat when it’s cool. It smells rather disgustingly garlicky for a while when it’s cooking (I thought that we’d have to bin the first batch) but, amazingly, the end product doesn’t taste or smell of garlic at all and is tastier than the many other recipes that we tried with roasted bones, many different vegetables, more seasoning etc. Simple, reliable and good, hardly more bother than buying it really. I think that the key factors in getting the most goodness out of the bones is the long slow cook and the acid.

  16. here’s a question regarding fructose and PUFA. if fructose is really shunted directly to the liver, isn’t there a greater chance of funny stuff occuring with glucose and PUFA?

    also, since fruit and nuts are often eaten together… don’t we have a problem there? yikes.

    should their be concern about eating fruit with meat – glycation of the proteins? is fructose really only safe eaten with SFA?

  17. George Henderson

    @ Jake,
    fructose is taken up by many cells, the liver only handles overload.
    See this brilliant Hyperlipid post: http://high-fat-nutrition.blogspot.co.nz/2012/05/on-glut5.html

    There are hunter-gatherer tribes who only eat meat and honey, pretty much. This was also the diet of the classical Ethiopian civilisation.
    From this, and what hyperlipid uncovered, it may be the combination of high fructose with even higher glucose that causes metabolic syndrome.
    Combining sweets and starches.
    Fructose is metabolised to glycogen when glucosse intake is low, as when fruit is eaten instead of starch.

  18. HI
    I am wondering if you could help me I have just purchased your book. Very interesting. I have been reading and following the bulletproof executive diet- intermittent fasting. I am feeling a lot better but the weight loss is slow. I keep on moving from 89 -87 kgs never budging.

    Having read your book i am wondering if i am doing the intermittent fasting incorrectly. I am also very confused, Taubes, the bulletproof exe… all state that calories don’t matter but this is contradictory to what you state in your book. So why the difference? especially when Taubes is such an advocate for the Atkins diet.

    I feel better doing the Intermittent fasting : But I would appreciate some guidance in regards to this.
    If there needs to be a calorie deficit : I currently weigh 88 kg at 163 cm tall.
    If i follow your protocol I am planning on doing the following:

    Fast from morning – 7am to 2pm ( intake only coffee with heavy cream about 1 tbsp and 15 mls MCT oil and 20 gms Butter – Blended)
    Nothing until – 2 pm when I break the fast with two eggs poached and green vegtables with 1tbsp butter(20 g)

    1700 hrs – I then Have a whey protein shake with coconut meat/ milk and water all adds up to about 250 ml – i have this occasionally or I have the coffee concoction again.

    1930 hrs Dinner is usually Meat about 100g with Vege and 150 g cooked white rice – use 1tbsp coconut oil to cook in

    When I counted calories : I equate it to this : 1300cals from Fat 300 calories from Protein and 200 from Carbs.

    I then stop eating from 8 pm onwards. In total i fast for about 18hrs.

    Are you able to let me know what you think of this. and if you can guide me better in getting the weigh off.
    I feel much better when I fast. But need the fat to stop the hunger.

    I look forward to your response. I am of indian descent hence being able to have white rice is a definate plus for me.


  19. HI
    I am wondering if you could help me I have just purchased your book. Very interesting. I have been reading and following the bulletproof executive diet- intermittent fasting. I am feeling a lot better but the weight loss is slow. I keep on moving from 89 -87 kgs never budging.

    Having read your book i am wondering if i am doing the intermittent fasting incorrectly. I am also very confused, Taubes, the bulletproof exe… all state that calories don’t matter but this is contradictory to what you state in your book. So why the difference? especially when Taubes is such an advocate for the Atkins diet.

    I feel better doing the Intermittent fasting : But I would appreciate some guidance in regards to this.
    If there needs to be a calorie deficit : I currently weigh 88 kg at 163 cm tall.
    If i follow your protocol I am planning on doing the following:

    Fast from morning – 7am to 2pm ( intake only coffee with heavy cream about 1 tbsp and 15 mls MCT oil and 20 gms Butter – Blended)
    Nothing until – 2 pm when I break the fast with two eggs poached and green vegtables with 1tbsp butter(20 g)

    1700 hrs – I then Have a whey protein shake with coconut meat/ milk and water all adds up to about 250 ml – i have this occasionally or I have the coffee concoction again.

    1930 hrs Dinner is usually Meat about 100g with Vege and 150 g cooked white rice – use 1tbsp coconut oil to cook in

    When I counted calories : I equate it to this : 1300cals from Fat 300 calories from Protein and 200 from Carbs.

    I then stop eating from 8 pm onwards. In total i fast for about 18hrs.

    Are you able to let me know what you think of this. and if you can guide me better in getting the weigh off.
    I feel much better when I fast. But need the fat to stop the hunger.

    I look forward to your response. I am of indian descent hence being able to have white rice is a definate plus for me.


  20. So I’m an ovo-lacto vegetarian, for non-health reasons (obviously), and I’m wondering about how to approach parts of the PHD, or if it’s even fully possible to eat similarly.

    I eat eggs and butter daily, but struggle with other protein and saturated fat sources. What are the big things I’m missing by skipping meat, and how can I adequately get the nutrients elsewhere, if at all? The prevalence of soy and vegetable oils in general is quite frustrating, too.

    Also, I’ve had high cholesterol in the past, and I’m thinking it’s been a lack of nutrition in areas, since the traditional “avoid saturated fat” has been busted and didn’t help at all for me.


  21. George Henderson


    the dose makes the poison, and the effects of PUFA are cumulative.
    Not a good idea to mix sugar and oil (as in bakery sweets or icecream) and if that was your problem, then it makes sense to limit PUFA and fructose as far as possible.
    But meat and fruit – if we’re talking one kiwifruit after a steak, probably not so bad, and not something I would have thought the PDH frowns on.

  22. Paul,

    The Bragg Company makes a very nice condiment, BRAGGBERRY Mixed Berry Dressing with Bragg Super Berries (Gluten Free).


    We enjoy it on salads and cooked vegetables.

    Would the fructose from berries and fruits make it not a good choice?

    Thanks, Bea

  23. Hi Paul,

    What version of your diet would you propose if I want to get rid of a possible bacterial infection causing depression and a minor but very persistent (15+ years) fungal infection (Athlete’s Foot)?

    In the past I’ve had some indications that ketosis might be good for my mood so I am leaning towards your version of the ketogenic diet (6 tbsp coconut oil, 200/400 carb/protein calories). Downside is of course that ketosis might contribute to the fungal infection’s staying power.

    Athlete’s Foot is obviously easier to live with than depression but perhaps it is or will be contributing to other health problems I am now not aware of?

    Is there a way to battle both at the same time?

    Many thanks,


  24. Hi Paul. I hate to ask a specific, personal question now that you are very busy with the new book but I’m in need. If you have no time, maybe one of your knowledgable commenters could advise me.

    I have been taking Synthroid for about 4 months and have brought my TSH number down from 6.2 to .86 which I’m happy about. However my T4 number has gone from 14 to 17 (scale 9-23) and T-3 from 3.9 to 3.7 (scale 3.5 to 6.5). My question is: why has the T-3 not improved? Instead it has gone down a bit. Should the T-4 not be converting to T-3? My doctor is NOT sympathetic, in fact he was reluctant to treat me at all.

    Will taking kelp improve the T-3? Should I try to convince my doctor to prescribe Cytomel – this will be a very tough sell! Will eating more carbs improve T-3 as I’m very low carb now? Should I stop worrying about the low T-3 and just be happy that the over all TSH is down?

    ANY info or advise will be most welcome!!!

    • As an additional comment to the above my hair has not even begun to grow back from my initial terrible loss over the winter!!!!!!

      • Is it alopecia? Is your vitamin-D level good?

        • Thanks for your reply, Wout. I don’t think it’s alopecia because I had the bad thyroid numbers which have corrected themselves, mostly, with synthroid. And I had the other symptoms over the winter – feeling tired all the time, and feeling freezing cold all the time.

          Anyone else that has a comment I’d sure appreciate it!!

          • Hi Barbara,

            We can’t tell much from your numbers. Lower T3 could be a number of things including eating fewer carbs or burning more of them.

            Feeling cold is a plausible hypothyroid symptom, tired maybe. What supplements do you take? Do you have gut issues?

  25. Paul,

    Additives in dairy cream –

    Carrageenan, Mono and Diglycerides, Cellulose gum,
    Polysorbate 80

    I looked up Mono and Diglycerides. One opinion online is that that trans fat and mono- and diglycerides are related – and thus equally dangerous.

    We live in a small town and a better brand of cream is not available.

    Would you skip the cream?

    Thanks, Bea

    • Hi Bea,

      Well, it depends on how much you like cream and whether you notice a reaction to the various additives (some people have quite strong reactions). If you’re not especially fond of cream, then I would use coconut milk instead.

  26. I’m a bit confused by omega-6 fats. From what I’ve read there are a number of forms, such as arachidonic acid (AA), gamma-linolenic acid (GLA) and linoleic acid (LA) and others. Beef, pork, chicken and other meats have omega-6 fat, but of a different composition than that in plant based foods. Omega-6 fats are said to be toxic and to oxidize easily. However, from what I remember in PHD (I don’t have my copy with me), the cited studies all used vegetable or seed oil. Have there been studies that show that the omega-6 fatty acids in beef or chicken are as easily oxidized and toxic as those in corn oil or soybean oil?

    Related to that, oxidizing of omega-3 fats apparently occurs even more easily than for omega-6 fats. Am I defeating the purpose of eating salmon if I cook it much at all, especially if at fairly high temperature (such as grilling), thereby oxidizing the omega-3 fats?

    I have the same concern about eggs. My son loves them scrambled, but I wonder if that oxidizes the PUFA and cholesterol in the yolks. I always have mine over-easy for that reason. I would poach them, but I like them so much better cooked over-easy in ghee.

    • Paul, any thoughts on my questions above? Just thought I would check in case my post got lost in the shuffle. George answered my question about the different types of omega-6 fatty acids, but I’d be interested in your thoughts regarding my concerns about salmon and eggs. Thanks.

      • Hi Frank,

        Linoleic acid provides the overwhelming majority of omega-6 in food, that is the reason for the focus on LA.

        The more double bonds a fat has, the more easily it is peroxidized. Thus, yes, the longer-chain omega-6s and omega-3s are more easily damaged than LA.

        Yes, salmon deserves gentle cooking. Curries and stews in which it’s boiled in water, or steaming, are ideal.

        I’m not sure that scrambling is much of an issue for eggs. Just cook on medium or low heat.

        Best, Paul

  27. George Henderson

    @ Frank,
    the more double bonds, the more easily a PUFA will oxidise. This means DHA and EPA will oxidise more readily than ALA (omega 3 – in that order) and Arachadonic acid and GLA will oxidise more readily than LA (omega 6).
    Monounsaturated fats (one double bond) do not oxidise significantly more than saturated fats, LA (with only two bonds) is about 100x more prone to peroxidation (at least, in a test tube).

    • Thanks George. I didn’t realize there was so little difference between monounsaturated and saturated fats in terms of how prone they are to oxidation. Makes me feel a bit safer in using olive oil for sauteing (using fairly low heat).

  28. Thanks for your answer, Paul. I take the basic supplements you recommend except the K2 which I will begin when my local store gets more in. As for carbs I have not been eating many in order to stay ketogenic and lose weight. I guess I should experiment with your recommendations and see where that gets me. How long should I do this before I re-test to see how the T-3 is? Several months?

    I have no gut issues that I am aware of. Digestion is fine, elimination is fine, no coated tongue or anything like that. The cold, hair falling out, and tiredness were the symptoms I had. With .50 Synthroid the cold, and tiredness have resolved – just the hair problem, and continued low T3 are the concerns.


    • Hi Barbara,

      You don’t need to be ketogenic to lose weight. Ketones are for neurological disorders, not weight loss.

      Going too low carb suppresses T3 levels and can cause or exacerbate hypothyroidism. Please add some carbs.

      Re supplements, I would try stopping selenium supplements and seeing if that helps. Dietary intake of selenium is unpredictable, and excess selenium will cause hypothyroid symptoms. But stick with iodine and magnesium.

      Best, Paul

  29. Paul, you are such a sweetie! Ok, I’ll try your suggestions. I’ll add some white rice and some potatoes/sweet potatoes to my diet, and some kimchi and salad veggies as well. And keep protein and fat in reasonable bounds as per your book guidelines. And ditch the selenium. I’ll report back in a month or 6 weeks and let you know how the T3 levels are reacting. God bless you!

  30. Paul – Here is yet more support for skipping breakfast and eating only 8 hours a day as you and other ahead-of-the-curve thinkers suggest: http://www.latimes.com/news/science/la-sci-fasting-diet-20120518,0,1060110.story

    • Thanks, David, great find!

    • To follow up on David’s post, here’s the Salk Institute’s press release:

      “This was a surprising result,” says Megumi Hatori, a postdoctoral researcher in Panda’s laboratory and a first author of the study. ” . . . By eating in a time-restricted fashion, you can still resist the damaging effects of a high-fat diet, and we did not find any adverse effects of time-restricted eating when eating healthy food.”

      Mice on a 60% fat diet were far healthier eating IF than ad libitum, but also fitter than mice given a 13% fat diet as control. So what damaging effects, if any, were found in the study itself? The mice on high-fat were fitter, and probably were fed Wesson. This demands a follow-up with healthy fat. Would also be nice to determine the ideal IF window, 8, 4, 2, 1 hour groups . . .

      • I struggle with one implication of this study — that a high fat diet is a poor choice, but a choice that can be ameliorated by a 16-hour fasting window. My family is concerned about my advice to cut their omega-6 foods and up their intake of saturated fats. They use the argument that when they were growing up the focus in our family was “freshly ground whole grains,” and now I’ve reversed my position. They are thinking the saturated fat thing will go the same way. Here is a study that promotes the 16-hour fasting theory while dashing the suggestion that good fats are, indeed, good, and in significant quantities. This study will give my family reason to avoid a high fat diet so that they don’t have to mess with this 16-hour “starvation,” as they call it.

        • Hi Pam2,

          keep in mind that the “high-fat” diet described here is not the PHD diet :-).

          Rat chow is carefully engineered to obtain a maximum desired effect, in this case (I didn’t read the actual study) they are probably feeding the rats something that will make them fat when they feed ad libitum. Think margarine and sucrose or something along those lines.

          • Wout, thanks for helping out.

            Pam, the “high-fat diets” in rodents are not especially high in fat (anything over 30% fat is called “high-fat”), but they are all malnourishing “purified nutrient diets” that consist of fat, sugar, starch, protein, vitamins, and minerals — no food. They are basically diets of junk food, the ingredient lists are similar to our junk food (imagine a Twinkie with a multivitamin). Similar macronutrient ratios provided as food do not cause similar health problems. So there are a lot of issues with interpretation of these rodent studies.

  31. I should’ve said I suspect the fat was margarine rather than butter given that the 60% grazing group appears to have done worse than the 13% fat controls.

    • Yeah Peter at Hyperlipid is always amused by what is covered by the “high-fat” monicker in rat chow.

      Just mentally replace “high-fat” with “obesogenic” and it’s much nicer to read.

  32. Paul — couldn’t find any mention of blue green algae (E3Live) on your website, but love the reorg. Both Gabriel Cousens and Brian Clement highly recommend it. What’s your take on its benefits or drawbacks. Thx

    • Hi tom,

      Blue green algae has a lot of lipopolysaccharides which can be toxic. I’ve become a little negative toward chlorella/spirulina/etc since learning that.

      • Thx, one more question: what about wheat grass? Does this just come under the caveat to avoid grain products in general or are there any therapeutic benefits to drinking “just the juice”?

  33. just got my results back from the lab
    Should I be concerned at how insanely high my Cholesterol up from Feb 2011

    Total CHOLESTERAL 4.42 now 5.51
    HDL CHOL = 1.02 now 1.06
    LDL CHOL = 2.79 now 3.78
    LDL/HDL RATIO = 2.7 now 3.36
    Triglycerides = 1.34 now 1.08
    Total Lipids 6.68

    Any feedback would be greatly appreciated.
    No. You have improved. 5.5 is a good TC number. Keep lowering the trigs and raising HDL for optimal health

    • Hi Ricardo,

      Your cholesterol seems to be in the process of normalizing, but you have some work to do.

      Optimal TC is 200-240 mg/dl = 5.2 to 6.2 mmol/l. You’re there. In 2011 it was too low.

      Your LDL at 3.78 mmol/l = 146 mmol/l is a bit high, but not worryingly so. It suggests an excess of oxidative damage to LDL and/or an impairment of LDL uptake, but only a slight problem which should not be treated with drugs.

      Your HDL at 1.06 mmol/l = 41 mg/dl is low. It should be 60 or higher. Find our post “How to Raise HDL” and try some of the steps there.

      High LDL could be due to several causes, including hypothyroidism, mineral deficiencies (iodine, zinc, copper are possibilities), or too few carbohydrates in the diet. I would try to be careful about diet and nutrition, and look carefully for any symptoms of hypothyroidism and ask your doctor what your TSH level is. You might read our LDL/HDL/cholesterol biomarkers category.

      Best, Paul

  34. There are so many diets, and every author quotes studies, believes his/her diet is perfect.

    For e.g. Colin Campbell might take issue with your perfect diet, and the PCRM.

    By what measure is an ordinary person seeking the healthiest diet to use, in order to determine which diet really IS perfect?

  35. From one perspective, Michael, you might look at the way the human body is designed – no need for “studies”. Those who say a vegan diet is “perfect” for people for example, could be refuted by looking at our digestive systems. We have guts and gut flora that are perfect for digesting meat and maybe some veggies and some fruit, but not so good for digesting grains and fibre. Whereas sheep and cows have digestive systems, and the flora they contain, that are perfect for digesting grasses. Again, no studies needed!

    You might want to read some of Denise Minger’s stuff on Colin Campbell. Pretty interesting.

    • Thanks Barbara, I agree that physiology is a good start. Thanks for the info about Denise, I’d come across it before… wow, she is smart 🙂

      I was very interested to buy the book but was REALLY put off by the 4 reasons stated to support the “perfect” macronutrient ratio.

      Loren Cordain’s Paleo macronutrient ratios are NOT as described here. Human milk does NOT indicate the macronutrient ratio of the diet… just as chimpanzee milk does not reflect their dietary ratio. We should NOT eat what we are (the composition of the body), but eat our NATURAL diet and finally, the behavior of omnivores given a free choice tells us nothing. The preference for fat in the wild is not the same as in an experiment. Instincts operate in a natural environment not in a lab.

      I find the logic behind the 4 reasons to be seriously flawed.

      • Hi Michael,

        I too wasn’t entirely convinced by those reasonings but I read them as pointers, all pointing in the direction of the proposed macronutrient ratios derived by biochemistry. I should probably reread but I think the most important arguments are those for not overdoing the protein intake and those for getting your energy mostly from fat.

        Obviously there is a quite large variance to what ratios people are eating while feeling fine so maybe the ratios aren’t important as long as your are healthy. Equally obviously there are people that really benefit health-wise from lowering carb or protein intake but they were unhealthy.

        So I would say that it’s hard to make a very strong case for a certain ratio but what is proposed certainly seems safe for almost anyone.

        • Thanks for that Wout. Actually my jaw dropped when I read those reasons because Paul seems to have such in-depth knowledge and yet the reasons are nonsensical. Paul if your reading, and you believe in your diet, please find another rational basis for recommending it, because these 4 are not rational and would lead one to believe that you have no logic 🙂

          • Hi Michael,

            They’re not nonsensical. Perhaps you’ll find them more convincing in the new version of the book, where the argument is made in more detail.

            Briefly, Loren Cordain was mistaken about some aspects of the Paleo diet. PHD is closer to the actual Paleo diet. Human milk is optimal for infants and infants differ due to their larger (relative to body size) brain and fast-growing brain; we can adjust for that. What we are is our natural diet. All mammalian diets tell us something, not just omnivores, about our nutrient needs; just as infant diets can be adjusted for brain needs to infer our needs; mammalian diets can be adjusted for digestive tract structure to infer ours.

          • “PHD is closer to the actual Paleo diet.”

            Well, that at least is rational. Why not stick with that and drop the rest which are not. And to be fair, you don’t say Loren says this thing, but we think he’s wrong because x, y, z, you just quoted his ethnographic data incorrectly.

            There is a type of baboon that eats grass. How does knowing their milk composition help in discovering what they eat? Same argument I made about chimps.

            The only thing that can help us is to look at what is our natural diet, look at what humans do when they don’t have text books or supermarkets, or are forced to watch Bambi when they’re children 🙂 What more do we need? The rest is diversion, and is NOT logical!!

            Just saying “yes it is logical” does not address the issue. And I am sure that using the illogical rational will be hurting you, it certainly put me off.

            When will the “new book” be available… I am seeing 4 illogical reasons in the Amazon preview 🙂

          • These 4 reasons set the premise for your whole book. I can’t get past them because they make no sense, as they stand. If you address Loren’s ethnographic data, and expand, offer correction, with supporting data, that makes sense, and needs no other supporting illogical data such as body composition, milk composition, or what mammals choose in a lab.

          • To say we should look at babies needs, look at milk and then extrapolate is frankly, ridiculous.

          • My jaw just dropped reading Michael’s series of posts 😀

          • Michael, it would be nice if you could be civil and more dispassionate in your comments as Paul, and almost everyone else on this forum, is. Paul welcomes dissenting opinions graciously. Perhaps you could return the favor. You don’t have to be disagreeable to disagree.

          • Woooooah who is being disagreeable? I am challenging those reason, yes, one I said was ridiculous because that’s how I see it, I think it IS ridiculous. Maybe you could see my comments as helpful even. If I am RIGHT, then wouldn’t Paul prefer to know? Wouldn’t you? It’s always tricky to read emotion by text alone. Rest assured, I have a smile, I’m a nice guy, and I really like Paul also, and I love how he interacts and gives freely, very admirable. However, the idea that we can extrapolate milk composition to tell us anything about diet, is, I’m afraid, ridiculous.

          • “You don’t have to be disagreeable to disagree.”

            That’s very good. 🙂 You will notice all my posts have plenty on smiley faces. If someone could engage the issue and show me how I am mistaken, that will be cool.

          • Michael,

            You wrote earlier, “There is a type of baboon that eats grass. How does knowing their milk composition help in discovering what they eat? Same argument I made about chimps”.

            Knowing their milk composition doesn’t help in discovering what they eat, and the book doesn’t say it does. Knowing the composition of human milk does, however, give some indication as to what nutrients a human infant needs. From that (along with other things the book mentions) Paul is extrapolating what a human adult needs, and using that to help determine what a human diet should consist of in terms of macro-nutrients. If you disagree that this extrapolation can be done, then please tell us why not. Simply saying it’s “ridiculous” isn’t helpful.

          • Hi Michael,

            People can and have said that the idea we should eat the “Paleolithic diet” is ridiculous. Why? Because people have eaten all manner of different diets at different times, and it is not obvious that evolution selected us for one particular diet.

            However, it is entirely clear that evolution selected breast milk to be the perfect food for infants. So we have a solid piece of evolutionary evidence to guide us.

            All four arguments are based on instances of actual evolutionary selection favoring consumption of particular diets or nutrients. Therefore, they are all solid indications of the actual human diet.

            Perhaps the logic behind these evolutionary arguments has not been explained well; mea culpa. But it is not the case that there is “no logic.”

          • Wayne D Johnson aka Prouddaddy

            Michael: Labeling ideas as illogical or ridiculous does not make them so. Please provide some useful arguments or go away.

          • Frank: “Paul is extrapolating what a human adult needs, and using that to help determine what a human diet should consist of in terms of macro-nutrients.”

            Yes, I’m saying it can’t be done. To prove it, I showed you how this model would fail for grass eating baboons and chimpanzees.

            Paul:”People can and have said that the idea we should eat the ‘Paleolithic diet” is ridiculous.'”

            Yes, but it has a logical rationale — that we have not been eating grains and dairy since the very start of homo, it’s only 10,000 years old or less. We can then example the effect of grains and dairy on biochemistry and the premise shows some promise.

            “However, it is entirely clear that evolution selected breast milk to be the perfect food for infants. So we have a solid piece of evolutionary evidence to guide us.”

            I don’t see how it can tell us anything about optimal macronutrients any more than baboon milk reflects the macronutrient composition of grass.

            “Therefore, they are all solid indications of the actual human diet.”

            No they are not, and you have not engaged the issues, you have not said, even briefly WHY. You just keep saying that they do show us. So… WHY does milk show us the macronutrient ratio? Why does body composition? WHY does the choices of mammals OUTSIDE of nature?

            These thing do not show us anything, unless there is a logical reason. What is it? All I need to do is show you other animals in nature when your model fall flat on it’s face to disprove the model.

          • Wayne: “Labeling ideas as illogical or ridiculous does not make them so. Please provide some useful arguments or go away.”

            Dearest Wayne, that is disagreeable and we don’t need to be diagreeable to disagree. Just sayin’. 🙂

            My arguments were all stated in my opening statement when I first challenged these reasons. Imagine you had a chimp, but you didn’t know what to feed it, what it’s natural diet was. Would knowing it’s milk, it’s body composition, or what OTHER mammals choose in a lab, help you find out? NO they would not. The same applies to humans.

          • Michael, the baboon’s diet is not grass. A cow’s diet is grass, and cows have rumens to convert the grass to fatty acids that its liver can transform into something closely resembling guess what — breast milk.

            Maybe a baboon was observed eating grass. Children have been observed eating dirt. That doesn’t change the fact that the diets of baboons and human children can both be predicted from breast milk.

          • Can ANYONE tell me, even in one sentence, WHY milk, body composition, or the choices of other mammals in a lab, tells us anything about optimal macronutrient ratios. Just give it to me straight.

          • Paul: Grass eating baboons…


            OK let’s stick to mammals. Are you saying that in every mammal, no matter what its natural diet, its food is absorbed in roughly the same macronutrient ratio as its milk?

        • Michael, my dog eats grass….then throws it up. Why are you here if you think the diet and the logic are bogus? Do you want to save us from ourselves? Thanks anyway, we’re happy in our delusions.
          You’re like a Twitter person complaining that he doesn’t like my tweets – just “unfollow”

          • (Different David here)
            Michael – I don’t think anyone objects to your challenges to Paul’s evidence. Personally, I like this site because he will answer any question, and I think we get closer to the truth when we consider contrasting viewpoints. So I think your challenges are welcome. But do you have to act like a child?

          • David: “Why are you here if you think the diet and the logic are bogus? Do you want to save us from ourselves? Thanks anyway, we’re happy in our delusions.”

            You may be happy to be deluded but who said you could speak for everyone? I personally like to be proved wrong so that I don’t stay ignorant, any don’t keep making the same mistakes.

            I am here because I did a search and was intrigued by the offer of “the PERFECT diet.” I was then flabbergasted by the premise of this PERFECT diet.

            I believe, as do the Jaminets, that the perfect diet would end an incredible amount of suffering, and create a happier world. So it matters, that’s why I came, and that’s why I’m here.

            And if someone is claiming PERFECTION, then they have a responsibility, because people are going to invest into it, there time, money and energy. And people are not experts, they will take things as read. For all those reasons I am here asking for clarification about WHY the PERFECT diet has any rational basis at all.

          • David: “You’re like a Twitter person complaining that he doesn’t like my tweets – just “unfollow””

            I ain’t complaining, you are. I am hoping to be proved wrong. You can stop reading this thread.

          • Different David: “But do you have to act like a child?”

            Hmmm I don’t get it. I am being honest — Premise one was not true, premise 2, 3, 4 seemed ridiculous to me. That’s just how I HONESTLY see them and I’ve taken a very passionate interest in nutrition for 20 years, so call it SHOCK if you like. I was shocked by these premises.

            How am I being childish, I am asking sincere questions and getting NO logical answers at all. From that I can only conclude that my assessment of the premises is correct. How else can I assess it, no one is answering with any reasons, no one is giving answers to my challenges that would PROVE ME WRONG.

            I only want to engage the ISSUE, it seems to be everyone else getting their knickers in a twist.

          • You are an exhausting person. Here’s a hint: if someone tells you you are being childish and you have to ask why, maybe it’s time for some reflection instead of rushing to post some more. Your passion is great, but it comes across as antagonistic due to the words you chose. Just suggesting you tone down a bit and focus on the issues instead of the vitriol. But I don’t really care. Your posts are by far the least interesting thing on this site and I won’t respond again because it is probably annoying other people. If you really truly do not understand why your tone is annoying, leave your email and I will help you understand offline how you could simply rephrase your posts to come across as friendly as you say you are in person (and I’ll give you the benefit of the doubt that you are). Regards.

        • Paul: You are using the outcome of gut bacteria processes, liver conversions etc to say that the FOOD should be of that ratio. The logic is flawed. By that reasoning cows would EAT as FOOD, the ratio of milk, even if your theory that “it all ends up as the milk ratio” were true.

  36. Hello.
    Hoping folks can post their thoughts regarding this latest study that says there may not be benefit in raising HDL: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960312-2/fulltext
    Thank you!

    • Hi BG,

      It just means that there’s no benefit to having a genetic defect in endothelial lipase, which has a side effect of raising HDL … It doesn’t mean that dietary steps which raise HDL won’t be beneficial. There must be some things which raise HDL and are beneficial to account for the association between high HDL and health. Odds are that a good diet is one of those things.

      Best, Paul

      • George Henderson

        Or is it that the things known to significantly lower HDL – sugar, smoking, heavy metals, micronutrient deficiencies – are such bad news that low HDL is a marker for toxicity?
        After all, attempts to elevate HDL don’t usually seem to go much above a healthy normal plateau. (Unlike attempts to elevate LDL).

        • Nice hypothesis!

          Note that there was a Comment on this study:

          These findings are consistent with previous mendelian randomisation analyses that also refute a causal role of HDL cholesterol in coronary heart disease.7, 8 Furthermore, they are supported by rare mendelian disorders such as Tangier disease, caused by mutations in ABCA1, resulting in very low HDL cholesterol concentrations, which do not show convincing associations with premature coronary disease.

          So in my eyes they’re establishing the boundaries of the high cholesterol->CHD hypothesis. They’re not finding much either, as we all expected :wink:.

          Also, the study only looked at genetic HDL markers, not actual HDL levels at time of CHD. Furthermore, CHD is not the only health problem humans have, so even if HDL is irrelevant for that are still plenty of other functions it supports, no?

  37. Ana Cheeseman

    Hi Paul,
    I’ve been following your diet for the past two weeks. I have suffered from IBS, gastritis, acne, and PCOS (I am very lean, though) for more than 15 years. I went to a naturopath once, who ran some tests, and told me that I’ve got a protein deficiency because of a lack of stomach acid. I have been eating more than 100 g of protein a day ever since, and my skin and periods certainly improved, although I felt very sluggish and I gained weight (muscular mass, mainly). I’ve noticed that since changing to the PHD my mind is clearer, my menstrual period is not that bad, but my acne has certainly worsened (I am doing intermittent fasting, but drinking 3 cups of black coffee a day). I was wondering how does the principles of protein restriction apply to conditions like mine (in which supposedly because I don’t have enough stomach acid I have to increase my protein consumption). I look forward to hearing back from you. Many thanks.

    • Hi Ana,

      You might try some steps to increase stomach acid, like eating more salt, taking betaine hydrochloride with meals, and getting tested for H pylori.

      The acne is probably driven by your gut issues / IBS and won’t be gone until those are cured. However, you may be able to ameliorate it by taking extra vitamin C, zinc, and vitamin A. You might try to a test of vitamin C to bowel tolerance (first appearance of queasiness or gut rumbling/gas) to see if that makes you feel better. Also, toxin removal steps may help the acne: salt, water, and potassium for urinary excretion; exercise to the point of sweating (or sauna) for skin excretion; glutathione for liver detox; vitamin C and taurine for bile flow; fiber (eg potatoes) and maybe bentonite clay or activated charcoal for fecal excretion.

      I’m not convinced so much protein is necessary, but listen to your body and do what works best for you.

      Best, Paul

  38. Hi Paul,
    I just read the book and am confused about how much rice I can eat. On page 104 you state that 3/4 cup of cooked rice will provide the daily 300-400 calories. I just bought a bag of Calrose rice and everything I’ve read online says a cup of cooked Calrose is <200 calories. Also, I just bought a ton of local honey and don't want it to go to waste. I know I should limit fructose intake, but is honey at least better than table sugar?

    • Hi Erin,
      regarding the rice info on page 104; that was an error which Paul has highlighted on the Errata+Index page here;
      Correct text should read;
      “Uncooked rice has about 1300 to 1700 calories per pound, but rice absorbs a lot of water during cooking and cooked rice typically has only 500 to 600 calories per pound. Thus, a cup (180 ml/160 g) of cooked rice will provide about 200 carb calories, and several cups of cooked rice may be eaten per day.”

  39. Billy Reinecke

    Dear Paul,

    Are you aware that your calculations for rice carbohydrate diverge by multiples from what I find elsewhere on the Internet? You write in your book that 3/4 cup cooked rice provides 300-400 calories. On Fitday.com, e.g., and everywhere else, I find that 3/4 cup yields 150 calories and 33 grams of carbohydrate.

    Judging by how I feel, I agree with Fitday. Thirty three grams of carbs per day leaves me quasi-brain-dead. Going with the other numbers I should be eating about two cups of rice a day instead of 3/4 cup to get up to the 400 calories you reasonably suggest.

    Ironic that I gravitated to your book because the sub 100 carb gram diets have left me with lots of promise and a lousy day, and following the formula I’m back to 33 grams of carb.

    The sweet potato calculations check out fine.

    What do you think?

    Thank you.

    • Billy – check out the post above yours by Erin. You are correct – it was an error in the book that Paul has corrected in errata.

  40. Caucasian
    Male 54

    History- Primal Blueprint 2007-2012
    results 180 lbs – 165 within 6 months 30% body fat – 12%
    Maintained with 6o mins exercise 4 days a week

    Recent increase in body fat and weight back to 2007 3 180 lbs and 30% BF since Feb for no aparent reason and
    Before feb 2011 – May 2012
    Total CHOLESTERAL 4.42 now 5.51
    HDL CHOL = 1.02 now 1.06
    LDL CHOL = 2.79 now 3.78
    LDL/HDL RATIO = 2.7 now 3.36
    Triglycerides = 1.34 now 1.08
    Total Lipids 6.68

    Wish to abandon primal blueprint model the Sissons regimen and convert to use PHD loose the 15 lbs and BF % with PHD.
    Please recommend an effective fat loss meal plan and post maintenance meal plan.

    Your book ordered on line from Amazon.com today – cant be found in HK bookstores !!

    Thanks a million and looking forward to your feedback.
    Hong Kong

  41. “Frank: “Paul is extrapolating what a human adult needs, and using that to help determine what a human diet should consist of in terms of macro-nutrients.”

    Yes, I’m saying it can’t be done. To prove it, I showed you how this model would fail for grass eating baboons and chimpanzees.”
    Do you know the composition of the milk of those grass-eating baboons and chimpanzees? Do you know what the grass gets converted to when they digest it? Unless you do (and unless those two things are significantly different), you haven’t proven anything. Maybe the local grasses are the best (or perhaps only) way in their habitat for the animals to get (or for their bodies to produce) what they need. That doesn’t mean that what they end up with is significantly different that what their infants get directly from milk.

    • Frank: “Do you know the composition of the milk of those grass-eating baboons and chimpanzees? Do you know what the grass gets converted to when they digest it? Unless you do (and unless those two things are significantly different), you haven’t proven anything.”

      What the grass gets converted to is IRRELEVANT because Paul is saying the DIET, i.e. FOOD, should be an extrapolated ratio of milk.

      I know chimps share 98+% of DNA with humans and I know they eat mainly fruit for calories but also lots of THV (terrestrial herbaceous vegetation) and about 5% animal foods — eggs, insects, small mammals.

      You can’t SERIOUSLY be suggesting that all mammalian DIETS are an extrapolated ratio of their milk. I repeat… the idea is ridiculous.

      • Please, please just give me a logical reason, or some evidence to back this up!

      • actually the idea is not ridiculous, it’s a good hypothesis that needs testing, preferably by lots of individual users. it’s no more or less weird than any of the other ways of eating out there.
        personally i do not eat this way, but i came through here on the way to where i am now, but i still enjoy the ongoing exploration. the fact that people get vehemently fired up about this is unhelpful in my opinion.

      • Just give me a few examples of various mammals where the DIET is an extrapolated macronutrient ratio of the milk based on brain glucose needs. Just a few examples will be fine.

      • Hi Michael,

        Now we’re getting somewhere. You’ve simply misunderstood me.

        I’m saying the diet should deliver (post-digestion) a nutrient mix similar to what breast milk delivers (post-digestion), adjusted for the altered nutrient needs of adults vs infants.

        It happens that breast milk undergoes relatively little alteration in the digestive tract, while grass undergoes a dramatic alteration.

        Many primates are able to do a tremendous amount of fermentation in their guts, no doubt geladas are among them. Fermentation of fiber creates byproducts that are readily transformed in the liver into something very similar to breast milk.

        Humans don’t have a large capacity for gut fermentation – we can ferment 5% of energy at most. So our diet has to resemble the composition of breast milk much more closely than a gelada’s.

        • Paul: “I’m saying the diet should deliver (post-digestion) a nutrient mix similar to what breast milk delivers (post-digestion), adjusted for the altered nutrient needs of adults vs infants.”

          Thank you, that is certainly clear, but I just don’t get this. WHY should it. E.g. chimps and humans share 98% of DNA, they don’t eat in their diet anything remotely close to 65% fat that you suggest for humans. I’m trying to see how this model works. If you say, well chimps eat x fructose and that is converted by their liver and ends up as fat, great, it doesn’t mean they’d be better to eat fat and not convert fructose. An animal should eat their natural foods, their bodies having millions of years of adaptation for that in the vast majority of species.

          This whole milk, body comp, and choices of mammals just seems to be confusing the issue.

          If I had a chimp but didn’t know what to feed it, it would be wise to look at what chimps eat in the wild. Why is it any more complex than that?

          • Yes, chimps and other apes do eat 65% fat after digestion. Have you read the book? Chimps and gorillas can be healthy on high-fat (breast milk) or high-fiber (converted to fat) diets, but not on high-carb diets.

          • Their DIET is not 65% fat, but you are saying a human DIET should be 65% fat.

            If you say all mammalian diets end up like milk after digestion and processing, so be it, if that is true. But PLEASE Paul, tell me, simply WHY looking at milk, tells us anything about macronutrient ratios. You just keep saying that it does. HOW does it, WHY does it?

            I have not read the full book, I have read the preview on Amazon. And you said you have corrected some errors in the new one, which I think you said will be ready July? I will certainly get the new one.

            Please Paul, can you just give me something that I can get my head around that makes sense, that show WHY milk can show us the optimal macronutrient ratio of the diet.

            Mammals eat all sorts of diets. All if it ends up similar to milk post processing that is interesting. But I fail to see how we can reverse engineer this fact, if indeed it’s true, to get to optimal macro ratios.

            You keep saying “it does” I keep saying “WHY” and we are getting nowhere. 🙂

          • By what method, can we look at any mammals milk, and correctly identify their adult optimum macronutrient ratio?

            The idea seems bizarre, but if you say it can be done, please tell me how. 🙂

          • Michael:

            1) Their post-digestion diet is 65% fat.
            2) Humans also do best on a post-digestion diet of 65% fat.
            3) Humans, but not other apes, lack an ability to transform fiber into fat (limit is humans 5%, apes 65%).
            4) Therefore humans need to get their fat as fat, apes can get it as fat or fiber.

            What’s so hard to understand about that?

          • That’s easy to understand. I’m saying I don’t see your “therefore” is valid.

            1. The fat content of milk is optimum for the system — the system of giving nutrition to a baby, including the volume of milk that is possible for a mother to transfer. Fat is clearly a less voluminous energy source. The biochemistry of the baby is optimized for milk, it a perfect close system. Once past weaning, the biochemistry is optimized for food.

            2. If we ASSUME 65% fat post digestion, this is no way infers that the diet of humans should be 65% fat. We don’t need to change fiber into fat, excess carbs are converted to fat. Fat calories come with their micronutrient profile, carbs with theirs. We should eat natural foods. It does not follow at all that the diet should be 65% fat.

            3. Lowland gorillas I know convert fiber to fat, I imagine that chimps have a much less ability to do this, more like us, although I don’t have the data. We can’t assume gorillas and chimps are the same. Chimps get most of their calories from fruit.

            4. The whole premise is flawed. Your statements do not lead to a THEREFORE, to a conclusion. We cannot conclude we should eat 65% fat from these statements. That is a leap that is not logical, and does not make sense, even ASSUMING “humans do best with post digestion 65% fat” is true.

            Humans in the wild eat a wide variety of macronutrient ratios and they all seem to be robust and healthy provided there is enough food, all without the lifestyle diseases that are killing us.

            While I think there is value in recommending a macro ratio being the best guess average that humans eat, that wouldn’t be 65% fat. Loren’s upper limit of fat is 47% based on the ethnographic data (28-47%). If a person knows their historical racial diet and it’s high in fat, it seems much more likely that a high fat diet will suit them… e.g. inuit/eskimo.

            But for general advice, imo 65% is way out of the ball park, and to me, anyway, your logic isn’t valid.

            If I am wrong, then I sincerely apologize for bothering you. I am going to get the new book, just out of shear curiosity.

            It may be useful to you — my experience here because I could not get past the premises. You may consider restructuring the way you present advice so that it doesn’t trip people’s BS radar 🙂

            I wish you all the best, I value your efforts in discovering the perfect diet and I have no doubt, that your motive is humanitarian.

            I won’t bother you with the other 2 premises, maybe we should leave things there 🙂

            Thanks again… please feel free to delete all my threads.

            God bless you.


      • No Michael, I’m not suggesting that “all mammalian DIETS are an extrapolated ratio of their milk”, and haven’t said anything of the sort. The book doesn’t say that either, and even mentions the example of cows eating grass but then converting it to something similar to milk. Why would it include that example if it were trying to make the claim that all mammals’ diets are extrapolations of their milk? This whole line of argument on your part is simply absurd, and nothing but a straw man.

        I obviously don’t speak for Paul or the PHD book, but my take is that the book theorizes what the nutritional needs of the human body based on a number of things, one of which is what is provided in breast milk. It then provides a set of dietary guidelines that the authors believe will provide those things in a safe way (e.g. avoiding toxins). It absolutely does take into account what the human body does with what it ingests, and if you disagree with that then you’ve obviously not read the book. The book also references numerous studies that were used as part of forming the guidelines.

        And personally I don’t care what other mammals eat. They’re much more limited in what they have access to than we are, and that drives their diet in a big way.

        Bottom line, if you disagree with the diet described in PHD, give us some substantive reasons for that rather than creating a diversionary argument. What do you think would be the healthiest diet for humans and why?

        • Human foods: fruits, vegetation, nuts/seeds, animal foods like meat, eggs, fish, shellfish, liver, marrow etc but not dairy. 20% protein, 30% fat and 50% carb. Macro ratios don’t need to be exact and can vary quite a bit as they would do seasonally in the wild, but these ones would be great, imo.

        • Oops forget the why part… why is because these are universal human foods and the ratio is a SAFE workable one that keeps everyone happy… it’s within AMDR of govt advice and only a teeny bit outside the Loren Cordain’s paleo ratios on the carb value.

          • Amazing – after all that bluster and blistering critique of Paul’s reasoning, your reasoning is it is good to eat “universal human food”? So why don’t you eat rice, soy or peanuts? And how did you determine the universality of these foods? Either you haven’t articulated your “universal human food” criterion sufficiently, or it is simply without basis. So now it’s your turn to defend your rationale.

          • Rice, soy and peanuts are not universal are they… going way back, millions of years ago.

            The universality is defined by how long “we” have been eating them and hence how likely we are to have adapted fully. I believe there is a universal diet that all humans will do well on, whereas some foods can be tolerated only by certain racial groups. The diet we can all do well on is the items I listed, and I would suggest that eating them in quantities traditionally used are prob optimal e.g. all over the world, a meat portion is about the same, as is a carb portion. I reckon everyone would be flying on such a diet. 65% fat though is way out of my mental comfort zone right now. And I’m not sure why you have a problem with my diet or reasoning, it’s back by millions of years of evolution and tradition, as far back as we can go. It’s a safe middle path that will work for everyone I believe.

          • 65% fat by energy, not weight. It’s yummy, try it 🙂

            BTW, none of the things you claim can be easily proven – how much meat did Grok eat on an average Tuesday? – so I’d say those are not convincing arguments by your own standards…

          • That’s rather haphazard criteria. Dark chocolate is not a universal food by your definition, but yet it is universally recognized as extremely beneficial to health. Ditto coffee, tea, yogurt, seaweed and kimchi, for example. Your universal human food criterion is not rigorously determined, it excludes extremely healthy food, and this is not to mention disparities in different cultures (e.g., cows were not domesticated until the neolithic period and never eaten by devout Hindus; pork is not eaten by Muslims and Jews, landlocked peoples might not eat fish; Innuits didn’t eat chicken, most vegetables and fruit, and many other foods that other humans eat). But most importantly, it just seems like an arbitrary distinction that does not sufficiently take into account human biology. A very flawed diet, IMO.

          • David: you dissing my diet cos it does not have chocolate, coffee, rice and soy… that’s just silly. I’m talking about a diet all humans can do, and would result in superb health. Right now, I think a middle of the road macro ratio is SAFEST. I don’t get your problem? How can a universal diet take custom into account or foods not part of of evolutionary heritage. Your arguments make no sense.

          • Dear Wout: “BTW, none of the things you claim can be easily proven – how much meat did Grok eat on an average Tuesday? – so I’d say those are not convincing arguments by your own standards…”

            Do I need to PROVE that humans and prehumans have been eating fruit, veg, nuts/seeds and animals for millions of years? Really? There is ENDLESS info saying that is true. I’m also saying that the human body is highly adaptable to variations, seasonally of these food groups but that a middle of the road macro ratio is safest to advise. What’s not to be convinced about by that? What needs to be proved is already in doubt, whereas what I am suggesting is self-evident — these are foods that can be taken directly from nature, need minimal processing and have always been eaten.

    • And actually, I don’t need to prove anything, although I have given REASONS, because I am not the one make the CLAIM.

      If “one” is claiming the PERFECT DIET, then ONE should give reasons or evidence for their premise, that make sense, are logical and rational. That’s all I’m hoping for.

      • to play devil’s advocate, giving evidence for his claims is pretty much what paul does. the book, this website, his podcasts/interviews/lectures. whether you’re convinced or unconvinced by his reasons is another story.

        • Hey… I’m Devil’s advocate and I bagzeed it first. Thanks Darius, I think I will dip my toe in a bit more.

      • Michael – I am not dissing your diet. I don’t think you should eat soy (rice is ok), and yes, there are many studies showing coffee and chocolate consumption correlate to health and longevity. What I am dissing is your reason for eating like a caveman. It makes no sense to try to mimic what a caveman eats, even if one could figure it out with certainty. Read the book. Omega-6 in excess is unhealthy, yet perhaps cavemen ate a lot of it. Cavemen surely benefited from not eating sugar and grains. But this does not mean that anything they didn’t eat is necessarily bad for you. That is an extremely unscientific and illogical point of view. I am dissing your lack of logical thinking. And by the way, this sentence is unintelligible: “How can a universal diet take custom into account or foods not part of of evolutionary heritage.” It is not good English and I literally have no idea what you are trying to say.

        • Yeah, I guess I don’t trust science. I have seen every diet under the sun quote endless science studies to back their case.

          The fact is that the number of interacting factors is immense, and it’s easy for science to get it seriously wrong.

          I put my money on NATURE, on evolution, genetics. We are animals, we have a natural diet. If we just collectively focused on that and figure out the best foods for us, lots of bad things would go away, almost overnight.

  42. George Henderson

    What a silly argument.

    The PDH macronutrient ratios minimize the need for inter-conversion of, e.g., amino acids to glucose, fats to ketone bodies. Nutrients are present in approximately the amounts where they can be used efficiently and promptly. That to me is a better argument than the milk comparison, which is interesting, but just adds to the totality of circumstantial evidence.
    If you read one of Michael Eades’ posts on this subject, you will see that a wide range of disciplines have contributed to this view of diet. Anthropology, paleontology, pathology, history, zoology, genetics, biochemistry and metabolism all contribute to the evidence considered. It doesn’t hang on any one finding that might be disproved, or analogy that might be mistaken.

    The proof of the pudding is in the eating; you can try anything for a month to see if it works. Our support for the PHD and similar Paleo diets tends to be based on trial results rather than faith in any abstract rationale behind it, interesting and illuminating though they be.

    • George: I’m sorry you think me questioning the premise that we should eat the same ratio of milk (digested) is silly. I don’t see it that way. Perhaps abstract premises would be better avoided and the more digestible premises such as the Eades ones you mentioned, used instead, to support the whole rationale of a diet.

  43. George Henderson

    If you eat a high-carb diet, then, by the time the excess glucose has been converted to saturated and monounsaturated fat by your liver and fat cells, you do have access to something closer to full-cream milk, and this conversion doesn’t require fermentation.
    Even herbivores like sheep and cattle convert carb to fat, which is why their meat and marrow is so fatty.
    In herbivores and omnivores, it’s not so much the ratios from food as digested, fermented or not, but the way absorbed macronutrients are converted metabolically after digestion.

    • If cows convert their natural diet, so be it, if we convert ours, so be it, the point is to eat was is natural for the species.

  44. I’ve been lurking, but I had to comment. Michael has offered some reasonable challenges that no one was addressing directly. I actually had the same questions, so thanks for being stubborn Michael. Granted we don’t have Paul’s entire book here as reference, but even on these forums a rigorous standard should be upheld in these discussions. I think that’s all Michael was asking for. Whether his tone is “childish” is not relevant to the matter.

    And thanks Paul for your patience. This actually is very interesting despite the ruffled feathers 🙂

  45. So if I could ask everyone to point their passionate energy towards the original question:
    how would the macronutrients argument be best presented so that browsing would-be readers on Amazon don’t misconstrue the argumentation?

    Perhaps the biochemistry case should be made first and the four other arguments shown later in support?

    I remember being slightly taken aback the first time I encountered the milk argument and only being convinced after reading the whole explanation…

    • I think presenting the paleo angle… the ethnographic data, with correction and reasons, and then the biochem definitely. No flawed logic 🙂

      I can say, that I am very well read in nutrition, and was floored by these 4 premises. I don’t know if they hold up under intense investigation but that really is beside the point. If I hadn’t been so persistent in challenging, truly, I would never have got past those premises, they are just too “out there” and wacky sounding.

      • Your criteria are incredibly wacky. “Universal human foods”? Do you also refuse antibiotic medicine because Grok didn’t have it? Give me a break.

        • David: I wouldn’t refuse antibiotics if I needed them, but I will try to avoid that scenario by eating universal human foods so that my body is in the best shape to fight infections naturally.

          • OK, then we agree it is logical for you to take antibiotics. Why, then, would you refuse healthy food that a caveman never had the opportunity to eat? Better to prevent disease in the first place, no? Especially when pretty much everyone agrees dark chocolate is healthy. What is your reason for not eating it?

          • Er… David, Frank asked me what I thought was optimal, I answered, chocolate wasn’t mentioned. OPTIMAL health diet would be eating foods we are adapted to, natural human foods, in approx the right quantities, fresh and “organic.” I don’t trust science cos it keeps CHANGING. Nature on the other hand, you can trust. Nature is “what works.” It’s what has worked over millions of years. I would rather trust that. Is dark chocolate going to make a difference if you eat natural human foods with a bit of chic added. No, of course not, unless you’re allergic/intolerant. Can we not get into silly arguments, and stay focused on the seemingly illogical premises?

          • You’re obviously a sort of troll. I don’t know why people feed you.

          • All I ever asked for was a simple rationale for the 4 premises, some logic. If I’d have got the answer, I would have felt well fed and full up, and certainly (post digestion) well nourished. However, not one single logical reason has been given for premises 2,3,4, premise one — Loren is wrong about fat is all I needed. That explains that one, at least I know where Paul is coming from with that premise (although it is incorrect as stated in the book).

            So… all I have done, is keep returning for an answer that never comes, and then I get accused of being childish! 🙂 hmmm. Gimme logic, just a simple short statement of logic that explains why premises 2,3,4 are valid, or even just premise 2.

          • Michael, you don’t trust science because it is changing yet you believe in evolution and genetics?? Do you see the irony there? Look, I think you need to consult with your zoo keeper before you continue eating “universal human food.” Straying from your natural grass blade and grass seed based diet clearly is depriving your gelada brain of essential nutrients.

          • David: “you don’t trust science because it is changing yet you believe in evolution and genetics?? Do you see the irony there?”

            No I don’t, perhaps you will enlighten me.

            Nutrition is a BABY science, we don’t know all the science, science does not yet have all the answers. Today, this diet is best, tomorrow it’s another. Even today, science is used to “prove” a whole host of different diet from macrobiotics to PHD.

            On the other hand, every species has a natural diet that it has evolved to eat. Although it’s harder to discover with humans due to our rapid exodus from Africa, still the clues are there, and the types of foods pre-agriculture, consistent.

            No irony.

          • “Science is what you do when you don’t know what you’re doing.”

            — by “a scientist” working on the particle accelerator in Geneva.

          • Well, you’ve clearly got it all figured out, Michael. Your diet actually sounds pretty close to PHD. I for one will follow a book that is jammed packed with solid support for every assertion and is very persuasively argued (you really should read it before making up your mind that it is incorrect – the authors do not simply deduce that the diet should mimic the proportions of breast milk and then discuss how to do it for hundreds of pages; they delve into the evidence for each type of food they recommend). You can stick with your lay understanding of evolutionary genetics based on scant evidence (actually, PHD also discusses evolutionary genetics, but I wouldn’t say it forms the main support; it’s used more as corroborative evidence). We’ll probably eat mostly the same things. Good luck with your posting a thousand messages saying the same thing and critiquing a book you haven’t read. Cheers.

      • “I don’t know if they hold up under intense investigation but that really is beside the point.” Really?? Isn’t that the point of science?

        • The point I’m making is that the premises seemed ridiculous to me, and therefore many readers will not be able to “get past” them, cos they seem so whacky. David, you seem to always miss the point, please try, which will prevent repetitions.

      • Wayne D Johnson aka Prouddaddy

        Michael: I was going to apologize for suggesting you contribute something positive or go away, but then you added wacky to illogical and ridiculous.

        • Thanks Wayne… I nearly peed myself reading that, VERY FUNNY 🙂

          • Wayne D Johnson aka Prouddaddy

            Then we’re good now, and I’LL go away!

          • You missed “nonsensical” btw 🙂

            PS. I am truly sorry Paul if I have ruffled feathers or been childish. Please feel free to simply delete all these threads and ban me from posting. I don’t want to upset anyone 🙂 I just wanted a simple answer.

  46. George Henderson

    Once you convert the unused portion of that 50% carb to fat, as you will, then those ratios will look like the PHD. A 50% carb diet as you describe is healthy for a healthy person, but it seems to take a little more than a healthy diet to cure modern diseases; it seems to take carbohydrate restriction.
    Though it is possible that intermittent fasting could do the same thing on higher carb, it is hard to fast until you have glycaemic control, which lower carb restores.

    • If I have evolved to convert to fat rather than eat fat directly, then that is best.

      I take your point about a therapeutic intervention for insulin resistance.

      Thanks George.

  47. George Henderson

    Actually, allergy to cocoa is fairly common, and dark chocolate is in no way essential for health. The OPCs and catechins in chocolate are fairly common in food and there are large amounts in apples and berries.

  48. @George: not sure there is a food on earth that someone is not allergic to, even if it isn’t common. Also, according to a quick web search, chocolate allergy, which I’d never heard of, is extremely rare (ex.: http://allergynotes.blogspot.com/2009/07/chocolate-allergy-its-vanishingly-rare.html). also, I’m not sure you could call any food essential. there are some nutrients that it is extremely hard to get from multiple sources (e.g., choline, vitamin B12), but for almost every food that is extremely healthy, you could find a substitute to accommodate dietary restrictions. It is nutrients that are essential, not individual food. Still, I think chocolate is universally recognized as healthy, yet it is not something a caveman (at least in the old world, and at least not processed chocolate) would have eaten.

  49. George Henderson

    By cocoa allergy I really meant intolerance or sensitivity
    (gluten allergy is much rarer than coeliac, wheat intolerance or sensitivity)
    Based on case studies in Richard Mackarness’s book Not All in the Mind (an early Paleo text by a respected psychiatrist)
    “In my experience main offenders, besides cereals and sugars, are instant coffee, tea, chocolate, eggs, milk and processed foods” p. 136

  50. Hi Paul, someone just emailed me this article, what is your take on the study?


    • Nutritional cohort studies I find very problematic. Surveys are highly suspect and typically done annually, sometimes even less frequently. Quick: what did you eat last *year*? (also, pretend you are not an engaged eater, which you clearly are to be here)

      I don’t dismiss them outright… but read some of the massive issues with the Nurses Health Study and it will certainly cause you to question any findings based on any self-reported (dietary or other) data.

      All that said I haven’t dived into this beyond reading a) a single food survey (quick: what did you eat last decade?) and b) a four-year course of mental tests, both of which strike me as woeful attempts at science.

    • These studies always have the same issues. One of them is the surveying as John D explains, and some others are:
      – What is lumped into the “saturated fat” category? Any trans fats?
      – What other foods were they eating?
      – Were people eating saturated fat more likely to engage in other “unhealthy” behaviors? After all everyone knows sat fat is “bad for you” therefore if you’re eating it you don’t care.

      Any cohort study can at most hint at something that must be investigated further. So in this case, research would have to be done into the possible mechanism, if any, of “saturated fat” on brain function.

      Until this is done I will happily eat the healthy fats as explained in PHD, seeing as how there is no apparent plausible mechanism that would invite caution.

      PS: Paul if you read this, I hope you’re ok with us all commenting along with you? This is more turning into a forum for PHDers than Q&A With The Jaminets – perhaps it’s time to install the wordpress forum plugin? 🙂

      • Wout, I love that you’re replying! Thank you so much for helping out!

        We do need a forum and I intend to install one when the book is done, in July. I didn’t know there were WordPress forum plugins, I’ll have to look into their quality.

    • Hi JC, The general issue of the role of different fatty acids in lipotoxicity deserves a blog post or series, but my general position is that the thing to do is to cure the metabolic syndrome which gives rise to lipotoxicity, and you do that with a low PUFA diet. If you have metabolic syndrome, therefore excess free fatty acids, then an un-physiological ratio of fats, eg saturated:monounsaturated other than 1:1, is a problem. Since carbs/fructose get converted to saturated fat, the problem with saturated fat is only significant because of metabolic syndrome combined with sugar/wheat intake.

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