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. Steve Reichard

    PHD While Traveling

    Does anyone have some tips for doing PHD while traveling? Of course, I can come up with some ideas myself, but I’d like to see if someone has a better idea.

    At home, I have grass-fed beef & lamb, bone broth, coconut oil, Alaskan salmon, farm-fresh eggs, raw milk cheese, etc. Obviously these things do not travel well.

    And to make it more challenging, I usually travel with my children, who are 8 and 10.

    • Hey Steve! When I travel, I like to pack some Steve’s Original Beef Jerky with me. Their paleo kits and berky (for kids) are also good options. Sea Snax is by far the best roasted seaweed I’ve had and they travel well. You can get coconut oil/coconut butter in little packets (Artisana brand, I usually get mine off iHerb). Canned sardines are also a good option (as long as you don’t eat it on a plane). I also always seek out grocery stores to get hardboiled eggs, yogurt, raw vegetables and sushi. I’ve also have very good luck with finding a good restaurant by searching “gluten free” on Yelp. And last but not least,I try not to stress out too much about not being perfect with what I eat while I travel! I’d love to hear your ideas on PHD while traveling. Please share 🙂

    • You’ve gotten good suggestions, and I’ll add mine.

      In the car, I bring whole fruit and trail mix (nuts mixed with a small amount of dried fruit and 90% dark chocolate bits).

      Look for these things on the road (at Whole Foods, e.g.) or bring them with you in an insulated bag with an ice pack. If it’s a long trip it might be worth one of those coolers that plugs in to the cigarette lighter.
      – rotisserie chicken
      – veg, fruit
      – canned wild salmon or other fish
      – pre-made meatballs, hardboiled eggs or other protein
      – nut butter and veggie sticks
      – cheese
      – pre-made muffins or rolls like the ones posted in the recipe forum

      And I agree with the poster who takes it easy on vacation. I do the best I can and let the rest go. I find that my health improves on vacation regardless of what I eat.

    • Steve Reichard

      Barney Butter has snack packs of almond butter. Yes, it has some sugar (evaporated cane juice), but it’s pretty darn convenient.


  2. on the road I opt for Thai, Vietnamese, Middle Eastern, French, Japanese, Chinese or a steak house. Basically, anywhere you can get rice or potatoes with meat or fish and veggies. Just make sure they use olive oil, not other vegetable oil. fast food is a no go. and mexican seems really difficult for phd.

  3. Hello Paul and Everyone,

    I just found out that I have an oral spirochete infection. I’ve had issues in my mouth for years and finally found a holistic dentist who was able to identify what’s going on. I’m wondering if anyone has done any research on this topic and could point me to places where I can read more about this. From a very short search online, it seems a few dentists think there is a link between oral spirochetes and heart disease. And also, a few more fringe dentists are questioning the link between Lyme and oral spirochetes. I would appreciate if anyone has information about this subject.
    In case anyone is interested, the protocol my dentist recommended is to rinse with a goldenseal tincture twice daily and to use coconut oil for oil pulling once each morning. I’m to try this for 3-4 weeks and then get the bacteria levels rechecked.

  4. George Henderson

    Intermittent fasting (8-hour food windows) looks like a fix for lipotoxicity/hyperglycaemia too, from the Salk mouse study taken together with the human research.
    Supersize your low-carb by adding IF…

  5. What are some thoughts on CoQ10?

    I see it’s not explicitly recommended as a supplement, but it seems like there’s a lot of benefit. What would be a good amount to take?

  6. Ana Cheeseman

    Hi Paul,
    I have been following your diet, and I have been feeling great. However, I am concerned about being taking large doses of Red Bull through my caffeine consumption and supplements. I take around three cups of (fresh ground) coffee everyday. And these are the supplements I take in addition to a multivitamin:
    Daily dosages:
    – B Complex (50)
    – Glutathione 500 mg
    – Zinc Citrate 22 mg
    – Calcium D-Glucarate 250 mg / DIM 100 mg
    – Chromium Picolinate 200 mcg
    – Potassium 99 mg
    – Iodine 225 mcg
    – Vitamin K 45 mcg
    – Selenium 200 mcg
    – Taurine 500 mg
    – Vitamin C (ester) 650 mg
    – Gingkgo Biloba & Gotu Kola tea
    May I be creating my own Red-Bull? Am I taking too much of everything? Are there any interactions between these supplements?
    Recently, I have noticed that I have lost weight and that my blood has become thinner. My periods are heavy (but less painful and shorter) and my gums bleed more often. But other than that, I have been feeling great. What is your take on this?
    Many thanks for your help, as always. It is very much supplemented.
    60 kg / 1.63 cm

    • Ana Cheeseman

      I meant appreciated (instead of supplemented) =)

    • Hi Ana,

      I do think that’s a lot of supplementation on top of a multivitamin.

      I don’t think it can be assumed that Gingko Biloba (or Gotu Kola) is a healthy thing to be taking routinely.

      Of the supplements, the most likely to be toxic is the selenium. If you multi has 100 mcg, + 200 mcg supplement, then with a whole foods diet you could easily go above our 400 mcg limit. So I would cut that down.

      Folic acid is also likely to be in excess, since the B complex and the multi probably both have 400 mcg. I would get rid of one or the other.

      Bleeding could be low vitamin C or low vitamin K2. You might add a K2 supplement (you don’t say what your K is, K1 or K2), or extra C and see if that makes a difference.

      In terms of what’s missing, magnesium stands out. That’s probably the single most likely nutrient to be deficient in food.

      Best, Paul

      • Ana Cheeseman

        Many thanks, as ever, Paul!!! My health and energy levels have significantly improved with the PHD!!!! Thank you for sharing all this!!

        • Hi Paul,
          I have been following your diet for the past months and I have been feeling amazing!!! My acne has cleared up, my periods are normal, I have lost weight, everything’s been great!! What I have noticed however is a change in my eye colour. My eyes used to be dark brown but now they are hazel. I was wondering whether this is normal. I look forward to your reply. Thanks as ever.

          • Hi Ana,

            Congratulations! That’s great!

            I haven’t heard of eye color changes from any one else. Perhaps I’ll ask in an Around the Web.

          • One theory could be that the color change in your eyes is a due to a change in health (for the better in your case).
            Iridologists see the eyes as windows into the body’s state of health.

            Google iridology if your interested to find out more.
            & Google Images iridology for plenty of pictures & photos.

          • Thanks Darren. I’ve just read that increased zinc update and vitamin A may cause changes in melanin. Probably, this is related to changes in eye colour.

  7. I am wondering if you can help me! As a kid, I was almost never sick (only tonsillitis). I rarely had a cold or a fever. At 10 I occasionally started getting migraine headaches accompanied by an aura and vomiting. At 10 I also started having allergic reactions to raw fruits and vegetables (previously only pollen). I was diagnosed with ulcerative colitis at 12. I was sick until I was 17 and at 17 i ended up battling getting off steroids. I ultimately had to go through a flare up that I luckily got through in time to go to college (way underweight). After college I got a cat and wound up getting a whole host of worse allergies and “asthma.” with and sadly even after I gave my cat away, I often felt exhausted, had headaches and very frequent swollen glands. I can say that I never felt good. I never got typically sick but I started to notice that I never had a fever, in fact, I ran typically 97.9 to 98.2ish. I also was working in NYC downtown across the street from the world trade center on September 11th and I continued to work there for 5 years afterwards. After experiencing chronic migraines for years I found a doctor who helped me a bit (got me off of of over the counter meds) and In 2005 I left my job in hopes of some peace and went to grad school(not so peaceful). I had my first daughter in 2007 via c-section. It seemed I never healed and the scar was always irritated and inflamed until I had my 2nd daughter and the incision healed perfectly. Since then I have had a partial tonsillectomy and removal of a pilonidal cyst On another note, all my life I have had issues with needing to eat often. I now typically eat every few hours otherwise I do not feel well at all. I seem to have some low blood sugar or something…My newest issue is that 6 months ago, after a routine blood test my platelets were on the low range of normal (139-142 on 2 blood tests). I went to a hematologist who tested me on 2 subsequent visits which yielded 1 normal reading and then one slightly low in the low range of “normal.” She said she would not diagnose without a platelet count below 100,000 but that she thought this might be “ITP lurking around.” In the past few years I have had very heavy long periods and I don’t know if there is a correlation (could be from having kids). I do think that there are some underlying causes here and doctors are not willing to consider anything but their route way of doing things. After reading your site, I am hoping you might have some ideas or answers. Also to note, my mom has hashimoto’s disease, temporal arteritis (she just got off steroids a few months ago) and a blood clot in her leg and lug. She is 65 and in good spirits.
    To change my life for the better, I have eliminated all processed foods and am eating an “all natural” diet for the most part. I have been thinking about going on the gaps diet but am worried it will be too hard to stick to. I love my quinoa and brown rice, and an occasional slice of bread, but I am also desperate to get rid of my allergies and other issues. I am also afraid of the difficulty I will have in social situations and maintaing my energy! I hope to hear a response soon…

    • Hi Lauren,

      Each of these conditions results from multiple causes at work simultaneously, often a dozen or more, which is why doctors have a hard time curing them – they can only address one or two of the dozen. You have multiple conditions so you can guess that there may be 20 or more things wrong. Many of them are dietary, some are infectious. You just have to start eliminating the causes one by one, until there are so few left that your body can recover naturally.

      The first step is to read our book and implement our diet. Then, I would suggest getting a stool test to look for pathogens. Cats often give toxoplasma gondi, for instance. The Metametrix microbial ecology profile is a good one.

      You should read our Migraines category for others experiences with ketogenic diets. I’m not recommending that you try that immediately, but it may be worth a test at some point.

      It’s a long road but it is possible, even likely, that you’ll regain excellent health if you approach these issues systematically.

      Best, Paul

      • Hi Paul,

        Thank you very much for answering me. It is hard to find someone who is willing to help you and someone who can truly help you make changes. I am sure it is a long road but as I am slowly eliminating things now, I am hoping it will give me the courage to keep going. I am also happy to hear that you are encouraging that there may be a light at the end of the tunnel. I will read your book for sure and ask more questions while I am on my journey to health! Also, if you have another second to respond to me, how long if I start your diet before I can see some improvements (for more encouragement)? Thanks again!!

        • Hi Lauren,

          Usually within weeks, but it depends on how good or bad your current diet is.

          • OK thanks. I just started your book. My diet is not that bad, I think. I started a month ago all organic as possible (don’t know if that is nec, but I like it). Fats, using butter eggs but no dairy (maybe I should add that back in), about 2fresh vegetable juices a day and fruit. Nothing processed, no preservatives, but I have been eating grains, mostly quinoa, wheat berries, and cous cous. I’m guessing that’s off the menu. oh and no alcohol. I have had very few migraines in the last 10 days. I’ve had 2 in in 10 days, I usually have about 7! I’ll keep you posted on my progress! I hope I am on the right track! thanks again.

          • Lauren, no meat or fish?

            Quinoa if soaked long is probably ok (not sure though, it’s not eaten as much as wheat so if it has problems would that show up?)

            Wheat berries and couscous are wheat – not good…

  8. Hi Lauren, have you read Paul’s book? I would suggest you get a copy and give it a read. You’ll see that an all “natural diet” is perhaps not all you might be doing when your health is so compromised. Paul makes suggestions that might be more in tune with your needs, such as not eating grains, especially wheat.

    All I can say is READ THE BOOK! I hope Paul has the time to make some suggestions for you.

    • Hi Barbara,

      Thanks for writing me. I did not buy the book yet, but I am going to buy it tonight. Do you have any of the same issues as I do? Also, how long did it take you to see some improvements?

  9. Lauren, Listen to Barbara’s advice and read Paul’s book. Also go through the website for posts and comments and chances are you’ll get a lot of your questioned answered. Good luck.

  10. Hello. I wanted to share some recent research inline with not benefiting from taking omega 3 supplements: http://general-medicine.jwatch.org/cgi/content/full/2012/524/3?ijkey=x75B0Snl3GgEo&keytype=ref&siteid=jnlwatch&q=pfw-featured Thoughts/comments are appreciated.

    • Hi Brennan,

      that doesn’t seem to be a free text 🙁

      In any case, the book discusses the difference between Omega-3 supplementation and eating fatty ocean fish, finding eating fish much better than supplements, possibly due to the fragility of long-chain Omega-3 fats.

      • Hi Wout.
        Thank you for your response. Are you saying you can’t access the link? I was posting this as more support, in addition to the book, for getting Omega-3 from the source. The summary if you can’t access the link: “Editorialists note no clear basis for recommending supplementation with -3 fatty acids but do recommend a diet rich in fatty fish and plant-derived -3 fatty acids.”
        Maybe this link is better:

  11. Hi Paul, I’ve seen references to bloating in others’ questions but I’m not sure you have answered this specifically as it’s usually bundled with so much other stuff. I’m in pretty good shape, but when I try to eat more carbs, as you recommend – rice, potatoes, sweet potatoes – not so much with salads – I really do bloat – so I stop and go back to ketogenic diet. That sure flattens out the old tummy in a hurry.

    I would like to take your advice and add more safe starches for all the reasons you site in your book, but how can I stop this darned bloating? Is this a sign of a bad gut? Am I adding too much starch? Should I start with literally a teaspoon and go up very slowly from there? Or take one little piece of the kimchi a day and to up to two pieces a week until this improves? I hate the bloating more than anything and it’s really stopping me from adding carbs to my diet at all. Help!!!

    • i have/had the same problem with starches. my solution was/is to eat simple sugars – strained orange juice/tangerine juice from trader joe’s, and white sugar. works great, better than starches or dextrose for me – i’m not gaining fat weight, etc. just be careful to ramp up slowly and to eat/drink the simple carbs with meals, etc. you can do this in the meantime while you dig deeper into your possible gut issues. i know i have severe ibs/ibd but it may be impossible to cure, only to treat, due to the fact that my gut was damaged before birth and in my formative years.

      • darius,
        Interesting (or may be strange?) that dextrose (just another name for glucose) is problematic for you, yet sugar (50/50 glucose/fructose) is not.

        I wonder if the source of the dextrose (glucose) would make any difference. Most commonly its looks to be made from corn (maize), while other sources seem less available.

        • To clarify dextrose didn’t give me problems, I quite liked it, until I tried sugar, which is cheaper and felt better in a way I can’t describe specifically…

  12. Interesting, Darius, but I’m not sure I’d want to do that! I’ve had reactive hypoglycaemia in the past and I don’t want that to be a problem again. I get discouraged and retreat into eating nothing but meat/fat because I feel great on it and I stay very thin which I like.

    I’m not sure it’s good for me though and I hate that my whole life seems to revolve around “dieting” when I eat like that. Paul’s approach seems to be “normal” eating – a good goal. If I could eat like he suggests but not “bloat” I would…. Paul If you aren’t too busy could you recommend a “beginning” for me? I do take a Bio-K every night – one of those little bottles with a zillion probiotics in it with the hope they will repopulate my gut with good bacteria if that is the problem but it’s not helping with the bloating.

    • your fear isnt going to get you anywhere. your body will adapt positively if you progress intelligently. it’s obvious you’ve got maybe some orthorexia issues, hopefully you’ll break free from.

      if the bio-k isn’t reducing the bloat, then it’s another issue, perhaps enzyme deficiency from auto-immunity, excessive inflammation, hypothyroidism, could be lots of things.
      it’s not JUST bacteria that regulates gut function.

    • I think Darius’s idea of eating simple sugars is the obvious solution. You want carbs that get digested in the small intestine and don’t reach the large intestine (ie which lack starch, fiber, FODMAPs, etc). Unfortunately that rules out most foods. Rice is usually the best-digested food, if you eat it warm and chew it thoroughly (mixing it with saliva). If that is no good, then dextrose and rice syrup or tapioca syrup, possibly honey, would be the next best bet.

      The other thing you can do is get a stool test to figure out what it is that is infecting your colon. It may be treatable.

      Best, Paul

      • What’s wrong with fruit? Very easily digested. Simple sugars.

      • OK, Paul let me see if I have this straight. I can eat simple sugars which are carbs without fibre. In the past I would have thought this was a terrible idea. I would have seen it as a recipe for a blood sugar crash!!! I’ll take your word for it that it’s not.

        Your idea is that these simple sugars would be part of your carb/protein ratio, with the rest of calories coming from fat. For people with healthy guts the carbs could come from a variety of safe starches and veggies but from people like me who bloat we’re better off with the rice syrup type things.

        And that’s why Michael’s idea of fruit would not work – because all that fibre is not a good idea – sorry Michael!!

        • Hi Barbara,

          Well, do you have diabetes or prediabetes to give you a big reason to be concerned about glucose regulation?

          If you mix the sugars in with meals it shouldn’t have a huge effect on blood sugar.

          Fruit isn’t bad, not all fruits have a lot of fiber, you should test to see what works for you.

          • In the past, Paul, I always had to stay away from sweets as I would get the shakes, sweat, and feel terrible. That’s what got me started eating more meat and fat and very low carb – it was the only way I could feel good all of the time. But it has become a trap of sorts. A mental one as well as a physical one really.

            Your book has been a God-send as it shows a way of eating normally. But it’s very hard to take that leap of faith!!

            I did have a fasted blood sugar test about 5 years ago and ended up on the floor in a dead faint but the doctor said I was “border-line” so he did nothing and advised nothing. I took it upon myself to eat very low carb since then. I will try the take your advice. Thanks.

        • pvffffff. Speechless.

          • Michael, I did not take your advice on the fruit because I wanted to hear what Paul had to say. I appreciate your input, however.

            I may not be as well versed on the variety of options available as you are but your “speechless” comment was uncalled for. Have a pleasant evening.

          • I’m sorry Barbara, no offense intended. I agree with Paul about the intestines. It can be caused by resistant starch from starchy carbs.

            Eating fruit on an empty stomach, say 20-30 minutes before a meal, as a starter, or have fruit snacks between meals. Use fruit only for carbs for a while. The type of fibre in fruit is much gentler and is good for you.

            It may help you to get plenty of greens in your diet… salads and green steamed spinach, spring greens etc because these are wonderful for improving the good guys in the gut. I believe these are better than probiotics for the job.

            If you still have problems, you could use just fruit juice and gradually move to fruit, but I don’t think you’ll need to.

            I will butt out now, good luck! 🙂

          • Or as Paul says, add fruit to meals… like salads, or have it as dessert. Experiment… before, snacks, with meals, see how you go. 🙂 I think before is best but that’s me. I have a gut feeling that fat and fruit aren’t best friends because fat interferes with glucose metabolism. With you previous problems with sweets, fruit alone may be best. And the fibre and fructose will make it nice and slow on your blood sugar… and if you start with lower GL fruits, even better.

          • Michael, how does fat interfere with glucose metabolism? Since I love my potatoes with lots of butter I’d like to know if that’s problematic 🙂

          • Hi Wout…

            How is interferes is explained by lots of stuff I don’t understand 🙂

            Check this out and you’ll see what I mean…


            They suggest FFAs are a CAUSE of insulin resistance AND plat a role in heart disease.

            Since you guys are only aiming for 20% carbs — the equivalent of only 4 bananas a day, I see no reason to not get all your carbs from fruit rather than rice/potatoes because fruit is better.

            So the potato/butter thing isn’t required. When folks say they can’t give up butter because of the potato thing, I say “well give up potatoes” 🙂

            Also… in nature, and I believe that nature should be the guiding principle if we are ever going to make sense of nutrition, fat is always bundles with protein and carbs have little protein or fat. There are a few exceptions like fatty fruits.

            So we can easily do this by having fruit snacks or fruit as a starter 20-30 minutes before a meal…. fruit quickly exits the stomach.

            Then meals of meat/fish/eggs with low carb veggies like asparagus, broccoli etc, even higher carb ones like carrots and parsnips are fine I think because it’s about reducing the amount of fat to a level where it’s less of a problem.

            As I said, all this is on a gut feeling level at the moment, a nagging in the back of my mind. I do already have the fruit starters and limits potatoes and sweet potatoes to very small amounts, favoring other more nutrition and less carbitious vegetables to go with salads and stews which are my meal staples.

            I tend to be a “forest” man rather than a “trees” man, because I got into biochemistry and quickly realized that there are too many interactions to make sense of. But once you look at the forest, the big picture, nature, then biochem can be enlightening.

          • “I think because it’s about reducing the amount of fat to a level where it’s less of a problem.”

            Should have been…

            “I think because it’s about reducing the amount of CARBS to a level where it’s less of a problem.”

          • Also a clue is that every other animal that I ever heard about or read about, eat their food where it is. So, biochem is prob set up to deal with fat/prot, and carbs seperately, optimally.

            We CAN clearly combine them, and people do, and live long happy lives, but we are talking PERFECT here aren’t we.

            Maybe Paul will be able to explain the study and it’s implications. This is not something that’s talked about much because I think health authors instinctively know that asking people to do this, wouldn’t happen, so they probably ignore it as impractical. But it’s not really so hard to put into practice.

          • Also from this study…

            “FFAs have recently been shown to activate the IkappaB/NFkappaB pathway which is involved in many inflammatory processes.”

            The DREADED INFLAMMATION!!!!!!!!

            So it could be a big deal.

            Thoughts, Paul?

          • Yes, but…

            FFA are the same as Non-Esterified Fatty Acids (NEFA), which are basically not supposed to be in our blood in big quantities. Dietary fat intake does not automatically imply NEFA rising. So high levels of NEFA may be associated with disease but that doesn’t mean eating fat with carbs is bad. See http://lipidlibrary.aocs.org/lipids/ffa/index.htm for explanations.

            As for your other reasons, I’m actually not very fond of fruit, I prefer my potatoes and ice cream ;). Animals do what they do, homo sapiens has been mixing up the meals for a long time so presumably there’s either no problem or we’re at least partially adapted.

            I guess I’m saying that your fruit thing is good but my potato thing is good too 🙂

          • Thanks Wout, I wish I understood that link but I’ll take your word for it 🙂

            Yes, I agree humans have behavior very different from any other animal.

            Maybe fruit and potatoes is best 🙂

            As I say, it’s like a nag, a gut feeling but I haven’t yet researched into it fully.

            Loren Cordain, who talks a lot of sense, mentioned it in a newsletter way back, and I’ve heard it from other unremembered sources too.

            My data is very weak, I admit 🙂 Just something that may turn out to be true, I don’t know. 🙂

          • Hi Paul and Wout and anyone else who can shed some light.


            This is a VERY big deal indeed. I still haven’t got clarity but I feel it’s what’s happening to me… that my blood sugar is staying high because of the fat also in a meal stopping insulin working.

            The new info… Dr. Neal Bernard…

            “Here’s the problem: insulin is the hormone that escorts sugar from your blood stream into the cells of the body. It is like a doorman who turns the knob on the door to each cell, helps sugar go inside, and then closes the door. (…)

            But everything changes when you eat fatty foods, or when you gain a significant amount of weight. Insulin can’t work in an oil slick. When there is too much fat in the bloodstream, insulin’s hand slips on the knob. Unable to open the door to the cells, insulin lets sugar build up in the blood. Your body responds by making more and more insulin and eventually it will get the sugar into the cells.”

            Can anyone help? This strongly suggests to me that protein and fat should not be eaten with carbs, as in nature (apart from milk which doesn’t count).

          • Hi Michael,

            See http://wholehealthsource.blogspot.be/2010/02/saturated-fat-and-insulin-sensitivity.html

            Don’t worry about fat influencing insulin sensitivity.

          • Thanks Wout! Yeah I actually wrote to Stephan and he told me there’s no reason he knows of not to eat fat and carbs together. He has a great series on insulin resistance too, which I learned a lot from… cellular energy excess! Makes a lot of sense. 🙂 Thanks again.

  13. I’m a big fan of eating fruit on an empty stomach… I have it 20 mins before a meal as I’m prepping.

  14. So, when I suggest to family and friends that legumes are toxic they show me articles like this.

    Any good reply that would get them thinking?

    • Bad example? The only objectionable food on there are beans and even then it lists the ones that are hard on the digestion.

      For the rest this list may be asking you to eat more fruit than would be optimal (fructose) and it’s rather trigger happy with the studies showing thus or that. I bet if you look at those in detail very few of them are awesome studies.

      There are hardly any super foods that confer something some other food wouldn’t, but there is lots of “food” devoid of nutrition and loaded with anti nutrients.

      If they sent me this list I’d say they’re well on their way to optimal nutrition 🙂

    • I now realize you were asking specifically about the beans. The truth is that it really depends, I eat peas and short string beans for example.

      The more protein etc a bean gives, the more a plant will want to protect it. Here’s a nice list of toxins in food: http://www.healthy-eating-politics.com/toxins-in-food.html

      Note how beans are mentioned multiple times…

      • Thank you! Yes, I was referring only to the beans. Wasn’t sure how that link would work. I must be so careful. My sons grew up listening to my beliefs about health and diet, even as my perspectives have changed over the years. (Adelle Davis to Diet for a Small Planet to life crises survival to eating to be pain free to Weston A. Price to (finally) PHD) They are now married and it is not so easy to convince their wives that the SAD is indeed a serious step toward poor health. So, I must observe, in silence, the decline in the health of my sons. They grew up on hispanic dishes and giving up their beans will be as tough as giving up their tortillas. Thanks for the link and your crazy hour reply. I do wish I could get information on preparing the many veggies in ways that reduce the toxin load. My green drinks are out, I guess.

  15. This is for you Michael – I can’t reply way up there because too many comments have gone by…but I wanted to say “sorry” for my unkind reply to your “speechless” comment. Paul has set the bar very high on his blog. He is a gentleman and a scholar and always replies to comments and questions in the most gentle and kind manner. I did not do that!!! So I’m sorry I was uncharitable. You were impatient and you should have been.

    Paul has repeated his advise many times in the book and in posts! I perhaps should have looked there before bleating like a lamb here and annoying all your folks.

    Anyway, let’s all follow our “shepherd” Paul and always strive to keep the dialogue way ABOVE the bar.

  16. This question is for Paul or whoever can help. Are there any enlightened thoughts out there on how to prevent, stop, or reverse hair loss? I feel that there must be a connection between it and a healthy gut/immune system.

  17. Bless you… I wear my heart on my sleeve and speak my truth, which I prefer to treading on eggshells. But I see that everyone here is very polite and nice 🙂

    My way, has got me into a lot of trouble here. Oops 🙂 No way am I a TROLL boo hoo 🙂

    I know what it’s like to be suffering with ill health, how incredibly frustrating it can be, and the need to just reach out and have someone answer your question, to take away the pain.

    And so if you get a forum, where many people are sick, then perhaps it leads to a very gentle dialogue where nobodies eggshells are trodden on.

    Generally I prefer honesty, then one knows what one is dealing with, the truth of it.

    E.g. Because I went on a bit of a childish rant about the 4 premises earlier, Paul (if he cares) can see clearly how SHOCKED I was, the TRUE reaction. Whereas if I had gone away and composed myself and come back and been polite, Paul would not have seen the gravity of my reaction, and hence the possible/likely reaction of others.

    Anyway… everyone’s sorry and making up is nice, I feel we’re in a better place for having fallen out and made up.

    Revolution always begins with outrage. Just sayin’

    And… I will be a gentle lamb here from now on… like a soft breeze.

    I don’t like you being sick it bothers me, it bothers me that nearly everyone is getting sick because we’re not living right. I’ve very passionate about that, and perhaps that’s a big part of it too.

    Try some low GI fruit snacks and starters, see what happens. Softly, softly, catchy monkey.

    • Michael, you really are a card!!!! You know that we can be honest and nice at the same time eh? Keep up your advice and input too. And have a great weekend. Hope the sun is shining where you are.

      • “You know that we can be honest and nice at the same time eh?”

        I’m learning that here. Although if I may humbly say one last thing in my defense… I have NEVER been rude, I just said things insensitively that were taken as rude but were not really.

        Thanks… I’m just like a soft breeze now, you’ll see 🙂

        Yes the sun is shining here, cos I’m where you are, in UK 🙂

      • I guess I speak to everyone,even strangers like friends… see, I would say “I’m speechless” to a friend. My bad. 🙂 Won’t happen again. Sorry.

  18. I just bought the book, and have been paleo for one and a half years. I’d like to try this version of healthy eating, but I have read the whole book and only get vague recommendations for portions and amounts. I dont know how to figure out 400 carb calories! what am I missing??? I really wish there was an easier way to know what portions of things to eat every day. Im so confused!!! any assistance would be great!

    • Carbs – 3-4 fist-sized portions of safe starches a day, plus fruits and vegetables to taste. Ketogenic diet – 1-2 fist-sized portions of safe starches plus vegetables.

      Protein – to taste.

      Fat – only enough to taste good and satisfy your appetite.

      • I have had to work at upping my fat intake and now this comment has me wondering. I have 2/3 cup cream in my morning coffee, 2 T coconut oil in my fruit smoothie, butter on rice, potatoes, boiled eggs, and veggies, and often have a bowl of raspberries with cream. It seems like more than “only enough to taste good…” Have I misunderstood PHD?

    • If you want to get it perfect, try…


      I use it regularly, and it it’s a doddle to track macronutrient. You’ll quickly get the gist of what x calories of carbs looks like as potatoes or rice. It’s a good learning tool.

      There’s lots of other trackers online too, but fitday I know and use, and it does the job for me.

  19. How should I address hypothyroidism? I take a good multivitamin and follow the PHD religiously and still I shed a lot of hair. It just falls out, I don’t know what to do.

    • Hi Nick,

      In your position, I would research specifics, following the PHD as a basis if that is your choice, but then seeing how your ill health manifested can show you if any other corrections are worth pursuing.

      I rock solid basis is a healthy lifestyle, sleep, diet, exercise, sunshine and then add things relevant to you… like perhaps avoiding all soy products, look into goitrogens, address nutrient deficiencies and food intolerances etc. And more focus on getting your gut bacteria right (lots of leafy greens and probiotics), stuff like this which is know to specifically impact thyroid function.

      Stress much also be addressed, resolve worries, do relaxation (combine with sunbathing to save time).

      Research hair loss too, to see what comes up.

      Then you want to nail your protocol… what do you need to do every day to make it happen, get clear and follow through. Healing is always a multi-pronged strategy. Get everything working for you, your whole lifestyle and a specific protocol.

      You might want to look at iodine, some don’t advise it, that will need research.

    • PS my friend had the same issue, hers was definitely stress as the #1 root cause.

    • Once you’re sure you doing everything that can be done… give it time. E.g. leaky guts are the root of sooo much ill-health. Once gluten is removed from the diet, it takes time to heal, then things can begin improving. I 100% believe that gluten is responsible for a huge amount of pain and the dots are hard to connect once things start going pear-shaped.

      Research, nail the daily protocol, and give it time, a few months, see what happens.

    • Lots oily fish… that’s basic for all ill health, resolve chronic inflammation. Keep a diary too, what you did and when, what results you noticed etc. It’s amazing how easy we forget otherwise. Good luck Nick.

  20. I haven’t eaten gluten in years. I have a slowly receding hairline which I’ve come to accept. But lately I’ve been shedding a lot of hair. I can run my hands through my hair and it just collects in the sink. I’m not sure what to do.

    • Like I say Nick, collate info and see what applies and what can be changed. E.g. if you read about stress and realize “that’s me” then that needs look at. It you read about soy and realize “that’s me” that needs looking at.

      So you keep researching and refining your optimal daily regime. You need to nail down everything from sleep habits to what you’re going to eat for breakfast, lunch and dinner, when your going to exercise and get sunshine, appointments with the doc for nutrient analysis and so on. It’s a project you have to put energy behind.

      Then when you have nailed it, and done it, and if it’s still not better a few months in, I would say see a naturopathic doc who has the ethos of looking to lifestyle first. They can do diagnostic tests etc and are much more savvy about CREATING health than the average doc.

  21. I appreciate the responses. Believe me I put a lot of energy into this…probably too much which means stress is a big part. Im just frustrates because I am very strict about what I do with my body and what I put into it and yet I still shed hair. Question about fish..any cocerns about too much mercury? I take fermented cod liver oil instead.

    • Well I was going to say Nick, don’t get frustrated or stressed because that will make things worse. And unresolved problems are such an energy drain and put your body in a state that will REALLY not help.

      So ATTITUDE is important. Resolve to sort this but maybe do it by allocating x time a day to calm research, seeing what can be done, and then doing it.

      A lot of times we can end up doing so much stressing and frantic pointless computer time that we neglect sleep, exercise, food prep, sunshine… the things that will make a difference.

      I was like that. I was trying to map the whole biochemistry of the human body so I could figure out how to get well!!! It can’t be done. The best route is to put energy behind the things I said, nail your daily habits and remove stress.

      Stress can be remove by resolving worries so that EVERYTHING is off your mind. Like if your need attention to this, then make a decision about it, and do it, no endless worrying.

      I don’t worry about mercury because I don’t eat so much of the problem fish to be a worry. You can emphasize the smaller fish like sardines.

      Also, I use a lot of herbs and fresh coriander/cilantro for example chelates mercury.

    • Hi Nick, I don’t support fermented cod liver oil. Fresh fish and liver are best for DHA and A; but fresh cod liver oil will be better than fermented I believe.

      Hair falling out suggests hypothyroidism. I would go to a doctor and get tested. If you’re supplementing selenium, stop; if you aren’t, start. Keep a steady dose of iodine.

  22. Nick – don’t mean to be glib here, but as much as I have faith in PHD improving your health, there still are some aspects of getting old that are inevitable. I’ll wait for Paul to chime in, but if there is no diet-based solution, you might consider getting a close-cropped hair style like Jason Stratham and not worry about it too much.

    • Does pattern baldness happen like that? Hair falling out? I assumed that the usual way that happens is gradual, not with clumps coming out but I don’t know, cos I have lots of hair.

  23. I’ll work on the stress.

    David…I know getting older is inevitable but I’m only 28, this amount of hair shedding can’t be normal.

  24. Yes, Nick, I hate to say it but some gentlemen do lose their hair. Can you take a look at your Dad and Granddad, and Great-granddad? If it is genetic take comfort in the fact that the close-cropped look is really “in” right now and many men look terrific with that cut!!!

    If it is a health issue you’ll find a lot of good stuff recommended here as people chime in.

    • Regarding “male patterned baldness,” in the genetics class at university we were taught that it is a man’s maternal grandfather’s hairline that will most closely predict how it will go for a gentleman. My own dad passed away in his 40’s, so it’s hard to say what my sons might expect. Of course there is the belief that baldness in the front suggests a man is a great thinker, while baldness in the back suggests he is a great lover. Baldness in both front and back would, of course, suggest that the gentleman thinks he is a great lover. 😀

  25. By the way, Paul, please tell us the new book will have an index?????? Then we can look stuff up instead of coming here to ask questions we could find in the book!!!! Save you tons of time!!

    And don’t fret that the focus will be on weight loss. That’s the hook that will get many more people exposed to your ideas for eating for health in the end – win-win.

    • The new book will have an index, but there is an index on the web site. Under “Buy the Book” click either the “Errata+Index” tab or the “Color Companion” tab.

      • I think someone else asked this but I don’t find anything about it. Is the Kindle version of the book updated to include the errata information?

  26. I recently started taking a multi with selenium. Paul can you explain your recommendation. Why would stopping it prevent shedding? Also, what’s wrong with fermented cod liver oil, it was my understanding that this was the best option. Im trying to stay away from all fish because of the mercury.

    • Too much or too little selenium will cause hypothyroidism. I’m assuming hypothyroidism is the cause of your hair loss.

      Multi’s aren’t normally enough to tip you into selenosis, but if your diet is high in selenium then it’s possible. It’s probably not the multi, but why don’t you experiment with dropping it to be sure.

    • PS – Salmon and sardines which are low on the food chain are low in mercury.

  27. Ok. I will drop the multi and see what happens. It provided 200 mg. I will look into just supplementing with vitamin d. I will start eating some fish…but any particular reason why fermented cod liver oil is not good? I take the green pastures version with butter oil as well. I’m just trying to cover all my bases. Any other way to stop the hypothyroidism? I have increased rice consumption and started salting my food as well.

  28. I’ve read some of Danny Roddy’s stuff before but I’ve never been sure what to think about it. I will listen to the podcast and see if it has anything good to say.

    • I sense despondency Nick, and yet there is a guy who went through it and got his hair back. The things he talks about are really universal healing tools although his program is stricter than necessary for most because he wanted NO RISK whatsoever. Anything that was even remotely implicated was stopped.

      It’s hard to identify the cause/effect of biochemistry on every factor. In reality, there is “the big stuff” and the “little stuff.” Danny did it all, but you can start right away on the big stuff, and get that right and you’re nearly there.

      His quick-start guide gives you “the program” apparently for free, while the book gives you all the background. Why not just dive into the program and see what happens. I would if my hair was falling out in clumps. You can refine your “optimal health program” once your hair is back. Now isn’t the time to dither because the fact that your hair is falling out means your body is at breaking point, hormonally.

      So, go from 0-100MPH tomorrow and then dive into the nitty-gritty as you go.

      I’m going to get his quick start guide now and check it out.

  29. Paul and others,

    I have another question. I am the woman who got ulcerative colitis as a kid. I am now grown with 2 kids. Most recently, I have a slightly low platelet (possible ITP), GERD and bad migraines. My migraines are the worst because I have them most frequently (4-5 times a week). I am on day 1 of gluten free but for the last month, I have eliminated all processed food and I am preservative free. For the last month I had also cut out alcohol and milk. I think that it takes a few days for a food to show how it affects you but I did eat dairy int he last two day and have a headache today (they are significantly improved). I have gone to a neurologist for years and it is almost as though I can never describe the headache (if they are even headaches) I have and what the symptoms are. Today however, as I got the headache the symptoms were milder but easier to describe. It felt as though the headache was creeping up my upper back and nestling at the base of my skull almost like a slightly numbing feeling and a similar sensation at the top )closer to the front of my head). Once it settles in I feel disconnected, foggy and a little out of it. I am wondering if anyone hass had anything similar or if anyone has thoughts as to what it could be. I hope not the dairy because gluten free will be miserable without the dairy…any thoughts??? And if this sounds like anything super scary maybe don’t tell me because I have a lot of anxiety about being sick or dying)Thank you all for the support so far. I am confident I will be better (I haven’t felt that way in a long long time(!! Today day 1, gluten free, I know it’s not a lot but I am sticking with it!!

    • Hi Lauren,

      I don’t know how to interpret headache descriptions, but a number of people have cured migraines on the ketogenic variant of our diet. See the Migraines/headaches category for more.

      Removing food sensitivities is the other likely culprit. You’re doing well to remove wheat and dairy.

      Usually dairy is well tolerated after the gut heals, so removing it can be a temporary measure.

      Best, Paul

      • yes, good deal, will keep the dairy out. I have been using rice milk so I hope that;s ok. I always like time-lines though I realize they are not the same for everyone. How long does it take for the gut to heal? a year? I know I will see result gradually but ouverall?

        • I would say a couple of months. Even a little cut on my arm can take a week to fully disappear.

        • It depends on how long it takes to find and remove the cause. If improved diet and removing food sensitivities doesn’t do it, get a stool test, eg Metametrix Microbial Ecology profile.

        • I don’t have answers, Lauren, for I, too, would like to know the condition of my gut, as I was told 15 years ago that my joint pain was likely a result of leaky gut. I am writing to encourage you as you eliminate foods. I tried giving up wheat for two weeks but there was no improvement to my joint pain, so I decided that gluten was not my problem. Then I came upon info indicating that it can take up to two years to see results after eliminating wheat. I began the elimination again and after six weeks my joint pain was gone. Be careful of the rice milk. I could not find a brand that didn’t include one of the terrible oils (safflower, soy, or canola). Safflower causes me severe pain at the base of my thumbs. Canola doesn’t seem to cause me pain, but after reading the history I don’t want to eat it. I believe I am near the omega-6 end of the 6 year window (if you recall the mental hospital study in the book), and my system seems to be very sensitive to anything omega-6. There are some coconut milk products that might work for you. Don’t know if I can mention a specific company here, but I have some from MN and it has only Xanthan gum in it (don’t know if that’s a problem).

          • I second the notion that migraine relief from going grain-free can take some time. I didn’t notice much difference in headaches for about six weeks. Now, at 2 months, progress is slow but definite. Bowel symptoms, on the other hand, disappeared after 2 weeks. I’m never turning back!

  30. Oh and I left out my long time addiction to over the counter anti inflammatories. I am on a perscription med that is similar to alleve but trying my best to stay away from these because they are so bad!!!

  31. the anti-inflammatories are for the headaches…

    • right, reducing systemic inflammation is key in many diseases from migraines to IBD. many foods create inflammation, as well as lifestyle choices that create more stress than necessary. also take a look at all your hygeine and beauty products, carpets, ventilation, etc.
      some people use prednisone in a burst mode, maybe 60mg a day for ten days, and do that every 2 months. others just take 20mg every time they get a migraine and that’s it, enough to stop the migraine until the next time. with short dosing cycles such as these there’s no need to taper or create a physiological dependency.
      of course continually trying to find the root cause is #1, but we have to live in the meantime.
      i’d give ketogenic diet a try tho, because it’s less of a hassle than getting prednisone (although you can order it from mexico w/o a prescription.)

  32. Lauren, when I stopped gluten I had baaaad symptoms for about 6 weeks, so it may take a little while. Dairy is not human food, I would look to seriously giving it up.

    We always have to get to the root causes. Anti-inflammatory drugs temporary help your symptoms but don’t get to the root causes. Control inflammation by living right, eating right etc. A good diet powerfully influences hormones that control inflammation, which is root cause for many illnesses.

    The things you need to do are really simple things… removing grains and dairy (except white rice for PHD), eat more fish, no veg oil (to reduce n-6), eat plenty of veg and some fruit.

    These simple things and more create health, allow your body to function as it should, but you have to get clear about the end-goal and take the steps to put all these things in place every day.

    • Agreed, I do feel good about it, I will miss it all but my health and my family are far more important! what do you substitute for dairy?

      • Why is dairy not good after the gut is healed?

        • with ALL things, self-experimentation is KEY. dairy consists of so many things, let me give some examples: i cannot do milk, raw or otherwise, because of the lactose, i tried greek yogurt, all fat %’s and loved it, but it made me gain weight in strange ways, so i stopped, i CAN consume full fat high quality vanilla ice cream and it is great, i do this a few times a week. butter and ghee are fine for me as well but i tend to use coconut oil to cook with.
          if you are concerned with calcium deficiencies without dairy (a legit concern), then you can take some teaspoons of calcium carbonate each day. cheap & easy.

          • “self-experimentation is KEY”

            That can only show you immediate cause/effect, but the effect of many suspect foods is insidious… like the way gluten can destroy the villi, and leave a person a physical and mental wreck, with a myriad of health problems that seem impossible to unravel.

            You can listen to your body for whether it wants steak or an apple, but there are limits. Some foods are addictive.

            Eat natural human food and it’s hard to go wrong.

          • i am “retorting” because the internet and the paleo-sphere is rife with know-it-alls, who unilaterally eschew ideals regardless of individual realities.

            i have played the gluten game, and it goes like this: stop eating it for some time (maybe 30 days), eat it again and see how you feel 1, 2, 3, 4 days after. this IS self-experimentation. a person CAN track symptoms and make better choices over the long term, even without research studies to “prove” their rightness.

            the term addiction is a trap. i am addicted to eating a steak everyday, because i feel better doing so. i am also addicted to sunlight. it’s a slippery slope and we can do better with our terminology. “natural human food” is religious-speak. stop it.

        • Well Paul says he’s OK with it, but I disagree on that one. There’s a laundry list of problems associated with dairy that make it a problem. Casein, lactose just for starters. Milk has opioid activity like grains do as far as I know. It’s strongly implicated in many illnesses such as autism. Would you drink monkey milk? Or even human milk? Drinking milk after weaning is silly 🙂

          There’s loads of more reasons if you do a little research. There’s even a website called “notmilk” 🙂

          All in all, milk is not fit for consumption imo. There are some who say raw milk is ok, but pasteurization ruins it, or fermented raw milk products like kefir, but we don’t need milk at all so why risk it.

          The idea we need it for calcium is totally bogus and that’s a whole book on its own 🙂

          • i really doubt that you have enough nuanced experience to speak for what is good for all humans. just this premise alone shows your inexperience.

            some people do great with milk, some do not, and so on for every single food in existence.

          • caveat emptor

            And why are some of you people so hostile. I gave my opinion and you retort. Jees.

          • please don’t misinterpret my comments as hostile. that is not my intent. i think YOU are a good person, and whatever you choose to eat or believe is none of my business. your choices and behaviors on this forum show a distinct lack of nuance and breadth/depth of experience, for all their well-meaning (i fully know that you mean well).
            if you do not want feedback or replies, then there are some options for you: 1) do not reply or comment on open forums. 2) completely ignore all feedback and replies that disagree with your ideas.

  33. Lauren – dairy is not a human food in the sense that it is produced by cows, but it is certainly fit for human consumption for most people. I can’t speak for Paul, but I have read his book, and he recommends cream, yogurt, butter, cheese in moderation, and, also in moderation (due to potential issues with milk protein), milk. I think there’s a lot of persuasive evidence from Paul and many others that dairy is one of the healthiest foods there is.

  34. Also, Lauren, Paul has said this in response to a prior question: “Rice milk – the rice part is fine, but check the ingredients to see if they have safflower oil or other high omega-6 oils, or some other ingredients we would be wary of.” My approach is to use only whole foods, and just do without whatever I decide not to eat. For example, I don’t want to work around no bread by trying to find PHD-friendly flour. Some others may take another approach, but I just focus on whole, minimally processed foods.

  35. Michael: are you aware that every time you make a separate comment, it generates an automatic “admin” alert (“there’s a new comment to Q &A”) in my/our email boxes? I’ve received so many “admin” alerts in the last few days — so many of them yours — that my inbox is cluttered beyond capacity. All due respect, I didn’t join this group to listen to your every thought and comment. Why not start up your own group with your own subscription list?

    • tom, that’s the nature of subscribing to a comments thread. you can easily unsubscribe. i’m not defending Michael, but your comment is essentially towards everyone who comments, whether you like what they say or not.

  36. I disagree. The fact that I can “easily unsubscribe’ is not the point. That’s obvious. The point is that Michael has some interesting things to say but he’s dominating the conversation. He’s an intelligent guy. If he wants to make “that many” comments, he should start his own thread.

  37. On the subject of email alerts for new comments.
    I changed to using webfeeds instead, after my email notifications from all the numerous threads i was subscribed to across a number of sites becomes too large.

    Just my personal preference, but i find managing and tracking threads and blogs etc using webfeeds much easier and superior to emails.

    If you have no idea what i am talking about 😀 , have a look here;

    Pauls’ site uses the RSS feed type, depending on your browser type, you should see the RSS icon either at the right hand end of the url window or as a button on one of your browser toolbars. Click or select it and subscribe to the feed you want. The feeds you can subscribe to will match the web page (article) you are viewing (not all pages/sites will use feeds).

    Here’s a link that should give you a shortcut to the Q & A comments RSS feed.

    Hope this has be useful/helpful to at least one person.

  38. Michael, you recommend Danny roddys diet and then bash milk consumption. You should probably know that milk is a major part of his program.

    • Yes Nick, that’s no good, do the zone or PHD — which are actually similar diets. Interesting that milk is counted as an acceptable carb/fat/prot ratio in The Zone so maybe Danny is using milk for that reason… because of the hormonal control but there’s much healthier ways to do it, and simpler.

      You can use Danny’s info for looking into the causes of hair loss, and then as far as diet goes, look at The Zone first because the block method will give you ultimate control. You can even use fitday for fine tweaking because even the blocks don’t take into account protein from other foods. There’s also a way to adjust prob/carb depending on how you feel in the hours following a meal.

      If you need to lose weight, then use the zone as a weight loss diet. If not, then add more healthy fat. Then it’s starts to really look like The Perfect Health Diet.

      So use Danny for causes… the other causes will be good to get clear on like stress etc. Then get Mastering the Zone and PHD and glean what you can in order to control hormones and look after your thyroid.

      Don’t forget sunshine, sleep etc, get as many factors working for you as you can.

    • Oh… The Zone uses some unhealthy foods, when it was written, but Barry Sears has definitely become aware that protein, healthy fat, fruits and veg are the way to go to make up the recommended macro ratios via his block method.

      If you check out his websites quick start guide, you’ll see what I mean…


  39. Michael – why are you commenting on this page as an authority on PHD when you haven’t read the book? Sears recommends more carbs and protein than PHD, and there are specific reasons why 40% carbs and 30% protein is not recommended. This forum is for people who have questions for Paul Jaminet, not for what you consider to be the best diet, or the best mix and match of diets. It’s ok when someone knowledgeable answers a question, but I don’t think anyone wants to hear your personal take. You’re not a scientist. If you have a great new diet, just start your own blog and write your own book. I feel like every time you make a comment, you distract and distort what this diet is about. It’s quite annoying, and I agree with the other comments to the effect that you overdo it. You don’t really seem to know what you are talking about and you are way too confrontational and sarcastic.

    • The 40/30 of The Zone is for WEIGHT LOSS. Paul recommends cutting fat for weight loss. The Zone adds fat back once the diet is over and THEN the macro ratios of the two diets are VERY similar.

      In reality the two diet are almost THE SAME macronutrient ratios when we talk about a weight maintenance diet, and actually, even a fat loss diet.

      I find that VERY interesting.

      I see I’m not welcome. I ordered the book but alas, I’m not able to read until it arrives. I read the very long preview which gives lots of info. And of course I have thoroughly explored the website.

      I will finish with Nick cos he does seem interested in my views and then I will disappear. I totally take your point about this being a forum about PHD.

    • E.g. for me, Zone 14 blocks at 0.8 activity =

      100g protein = 400 cals, 126g carb = 504 cals

      I need roughly 2200 cals to maintain weight, so once I add fat, I’ll be eating 59% fat.

      Protein will be = 18%.
      Carb will be 23%

      Therefore The Zone and PHD have the SAME macro ratios.

  40. Tom Clements,

    I completely agree with your request. I love to read and hear about other individual’s questions and recommendations in relation to PHD through the thread. However, lately my inbox has been ridiculously full of Michael’s thoughts and questions regarding the integrity of PHD. It is very bothersome. If you do not agree with PHD or feel the need to argue over the core concepts, then just disregard the forum and stop wreaking havoc on those who follow it and have finally found stability with our health 🙂

  41. I’m sorry to say that I agree that Michael seems to have taken over here. This section is after all called Q & A. I thought we would ask PAUL questions about his book and how to implement it. He is so generous with his answers and we can comment a few times, then we can ask new questions. And on it goes.

    Michael, if you read this you’ll see that this is how it’s supposed to work. We really don’t want you to go away, just to see how this is supposed to work. If you can do it this way, welcome aboard. If not, please go away.

    If this continues to be Michael’s comment blog I for one won’t stick around.

  42. Yes I agree with that Barbara. I will stick to asking Paul about the PHD, once I’ve read it 🙂

  43. Hi Paul,
    Thank you for the great book! I follow most of PHD and feel great!
    This is my question:
    My son was dagnosed with alopecia areata when he was a boy. He was loosing hair on some spots and then after some time hair grew back. Now he is 28 and his condition became a lot worse quite abruptly. Now he has deformed nails in addition to hair loss. Doctors confirmed the old diagnosis (alopecia).
    He stopped eating bread (I am not sure about other cereals), eats all organic, but it does not seem to help.
    Any thoughts on how to help him?
    Any advice will be greatly appreciated.

    • Hi Alec,

      Alopecia areata is a T-cell mediated autoimmune disease. T-cell character is usually determined by the gut flora. I would wonder if some kind of infection in the gut was messing up T cell differentiation. I would therefore get a stool test to look for gut pathogens, eg the Metametrix Microbial Ecology test or something similar.

      Beyond that, vitamin D optimization and a few other things often help with autoimmune conditions. Just try to be healthy and optimize everything.

      Maybe the doctors have some therapeutic ideas.

      Best of luck to your son.

      Best, Paul

  44. Nick, fwiw I started losing my hair a few years ago. Because hair loss is one of the symptoms of hypothyroidism, I’ve read & re-read all the hypo-related posts on this blog, & found them quite helpful. I got the book & started following the diet, which means ditching the toxins, getting the macronutrients right & taking the recommended supplements. Iodine is particularly important for hypo, but you have to follow Paul’s “increase it very slowly” instructions.

    It’s taken me 8 months or so to get it sorted out, but at this point I’m not losing as much hair in the shower, my hair seems a bit thicker now & as an added bonus, I think there’s a bit less gray in it.

    In the book, Paul & Shou-Ching make the case for chronic infections as the cause of a number of diseases that until recently, have been thought to be part of the normal aging process. Male-pattern baldness may turn out to be something that’s also caused by a pathogen rather than genetics – certainly worth investigating!

    Hope this helps!

  45. Question for DARIUS SOHEI if he’s around today or tomorrow. Darius, you mentioned above that you were getting your carbs from “strained orange juice/tangerine juice from trader joe’s, and white sugar” as you have problems with more complex carbs. Can you be a bit more specific? Do you sip the juice along with your meals? What about the sugar? Do you mix that with the juice?

    I need to start with the more simple carbs too and would like to follow your lead but have trouble getting my head around this concept. I had two tablespoons of honey after breakfast today but don’t quite know where else to go with this!!! As it’s Sunday I won’t shop so I’ll get out tomorrow and get some juice to sip but any suggestions you have will be most welcome. I’d have no idea where to get rice syrup. I want to wait a bit before I add in real rice or FODMAPS fruits. Thanks

    • maybe it starts out more complex, but as you go and your personal data accumulates it starts making more sense.

      some ideas: add carbs slowly, and in relation to your body weight, total daily protein (at least 100g), protein in the current meal, total daily fat (anywhere from 50+g day), fat in the current meal (this is tricky, sometimes you want to do high carb with a low-no fat meal, just to get the carbs in, such as during extreme stress or post exercise), and finally how you feel after ingesting the carb (different results from drinking vs eating carbs for example)

      ok lets put it together: feeling a bit stressed, eaten a fair amount of protein already today, dont have anything major to do later on = full fat high quality ice cream with added egg yolks, salt, possibly some hydrolyzed gelatin for non-stimulating protein/collagen. you can even add sugar to this, or do a mexi-coke float. maybe some lactase enzymes to mitigate any fodmaps issues.

      another option, breakfast: steak or high quality protein plus sugary coffee or sugared mineral water. maybe 2: 1 ratio carbs to protein. lowish fat. theres fat in the steak/meat, but no need to add any other fats.

      if you get super sleepy after a meal (sometimes this happens if you just drink 2 glasses of oj all by itself, then people are like “omg oj and sugar is soooo bad” but really it’s just context), thats bigtime insulin release and hyperglycemia. learn from this. protein and carbs both do this. we are aiming for anabolic states of health, shutting off the catabolic state of stress, fasting, disease, etc.
      “too much” anabolicness = dreaded food coma lol

      best times to eat the high insulin foods are post stress, post exercise. so higher carbs, protein, less fats.

      i’m 6feet 185 lbs, moderately active. i get at least 200g carbs a day, some days up to 400g, and this is not even with intense exercise.
      i try to get 100-150g protein a day everyday. this is the foundation. if you dont get enough protein nothing else really matters.

      throughout the week i may have high calorie days, followed by low, same pattern with carbs and fat. protein stays the same generally. i can now tell what i need when i need it.

      many times sipping on ice cold oj with salt and gelatin, or sugared and salted sparkling water is what i need. the ice cold part is important for my satiation, similar to ice cream.

      i personally dont suggest rice syrup because theres still a lot of starches in it. i’d go for honey if you’re still fearful of the white sugar.
      i strain the oj because the excess fibers are fodmappy. the tangerine juice doesnt need to be strained in my experience.

  46. Steve Reichard

    Does anyone know if there’s a way to subscribe to ALL new comments on this website?

    I know about the Recent Comments section on the right side of the main page, and I know how to subscribe to a single topic, but I can’t think of how to subscribe to ALL topics, other than subscribing to each topic manually.

    • I think I’ve found a way to do it, at least with the firefox browser. When viewing a comments page, click on the ‘bookmarks’ button on the toolbar, then on ‘subscribe to this page’, and then on ‘comments feed’

    • Hi Steve,

      Here’s a general way to get at feeds, including our comment feed: in the white space on the blog, right-click and select “View Page Info”. Go to the “Feeds” tab. Subscribe to the comments feed.

    • Steve Reichard

      Both of these techniques work – thank you.

  47. hey paul, the last full stool test i had indicated no gut pathogens, but low gram positive bacteria and low siga. what are your thoughts on this? of course i still cant eat gluten, excessive lactose, or much starches, fibers, sugar alcohols, without excessive bloating and pains. if i stick to what i can digest, the ibs is generally almost non-existent, but can still flare even with too much stress…

    i am toying around with experimenting with VLS#3 in high doses for a month or 2 to see what it can do, but i need to do more research.

  48. Thank you, Darius, very much for your detailed response – you’re very generous with your time. I googled around and came up with something called Low Residue Diet. Of course they recommend eating refined grains, etc which can be ignored but they do list veggies and fruits that are low in fibre which was good to know. Funny nowhere is white rice mentioned at all! They say to stay away from everyone’s favourite “whole grain brown rice” though 🙄 !!

    And strained juices are listed. From what you have said, and with some of their list I’m good to start at least. Thanks a lot.

  49. Hi Paul
    Any thought about my coninuing these supplements on the PHD?
    1. Ubiquinol 100 mg.
    2. Nattokinase 2000 FU
    3. Bilberry extract 60 mg.
    4. Resveratrol/pterostilbene combination (Life Extension brand)
    5. N-Acetyl Cysteine 600 mg.
    6. Acetyl-L-Carnitine 1000mg./Apha Lipoic Acid 600 mg. combination

    • I don’t have strong feelings one way or the other. I’d be most positive to Ubiquinol, maybe ALA. Carnitine – extra vitamin C probably takes care of that. NAC – I’m supportive in infectious disease, but in good health more protein from meat would probably make more sense. Resveratrol/pterostilbene – personally I would avoid those. Bilberry – probably beneficial, but personally I would just eat berries, not sure I would trust pills/extracts (not fresh, modifications). Nattokinase – personally I would avoid that.

  50. George Henderson

    Some comments to the above:
    – ALA can increase requirement for thiamine and possibly biotin. Consider it as a B group vitamin when supplementing (it has a role in the citric acid cycle a bit like the distributer arm in a car). It’s not just an antioxidant.
    – NAC is good for diseases that feature oxidative stress, but not so good in health
    – You can get small amounts of reseveratrol and/or pterostilbenes in grape seed extract or pine bark that are closer to dietary levels and include the whole range of related compounds including OPCs. Personally I can’t stand resveratrol supplements, but I always feel better taking grape seed or enzogenol pine bark extracts.
    Nattokinase – they throw away the vitamin K2 when they make this. Why would they do that?

    • Thanks. Yup, taking the vitamin K out of the nattokinase seems ridiculous.The reason usually given is that it antagonizes anticoagulant drugs like warfarin, so maybe the FDA forces them to remove it. I guess they think that people may try combination approaches of prescription and natural clot-busting therapies and run into trouble..(or maybe they’re afraid that they won’t run into trouble and will instead be weaned from their expensive medications.

    • And that’s why I’ve been eating the natto itself as well. It’s one of the highest foods in vitamin K2, and it naturally prevents abnormal clotting. But, as Paul says, even though it’s fermented it may still contain harmful soy substances so we may be better off just supplementing with vitamin K instead?

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