Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. Hi everyone – hoping someone can assist with some advice/suggestions. I have tried PHD, but am still struggling with an addiction to carbs to help with stress and depression. Even though I know logically that eating carbs are going to make me feel worse, when feeling stressed or depressed, the urge for carbs/sugar is so overwhelming that I don’t care about the regret I feel later and just want it now to settle down. Does anyone have any suggestions as to how I can overcome and beat this? I know that nutrition PHD style is much better for me, but even supplements don’t seem to be helping the urge to binge on carbs.
    Thanks for any assistance.

    • What carbs? Something tells me you aren’t going to say that you binge on Orange juice for example…

    • Hi Caroline,

      Try easily digestible sugars. Your overwhelming desire for carbs probably indicates you need them; you just have to find a form that doesn’t make you feel worse.

      Then, I would go to a doctor and ask for testing for digestive tract pathogens (eg SIBO, stool test for colonic problems) to see if you can figure out why carbs affect you this way.

  2. Caroline… opioid peptides in wheat for e.g. are addictive… like Darius said, people don’t binge on oranges and apples. Like any addiction you have the cold turkey method or the cut-down method. I would suggest cutting down over 6-8 weeks until you have a gluten-free diet of only safe starches and fruit.

    • “gluten-free diet of only safe starches and fruit” — for your carbs I mean. When I stopped bread suddenly, I had severe withdrawal symptoms — hyperventilation, it was very unpleasant. I think toast is a good cut-down food because it breaks down the gluten a bit I read. Also… if you get into meditation and relaxation methods… you can use them when you start to feel stressed and nip it in the bud. As you get really good at these things, you will gain control over the stress reaction and be able to stop it.

      Regular exercise, even simple like walking can help a lot.

      • I have a similar problem to Caroline’s. I did much better (at not bingeing) when I avoided starchy carbs altogether…problem is I feel better having rice and sweet potatoes. I’ve eaten very few gluten containing grains for several years and I’ve gone completely gluten free for nearly 6 months. It’s a horrible feeling when you know darn well you need to limit your starch portion but there is an ‘addict’ in you saying ‘nothing doing’. I also avoid dairy.

        I’m starting to gain weight which is unwanted especially with having diabetes in my family.

        Another complication into my life is that I’ve developed ulcerative colitis and I’m still working on which foods are OK and which cause problems. I have to be careful of eating a lot of fiber.

        I walk or bike every day, garden (more like weedin 😳 ) everyday.

        My other problem food(s) are salami, apple and cheese which I tend to snack on in the evening.

        • Hi Heidi,

          Have you had a stool test?

          • No, I have not had a stool test. I’m in Canada, so we can’t just go an pay for a test as far as I know. I can ask my GI doc. What am I looking for please?

          • I like PCR tests for pathogen DNA in stool, like the Metametrix Microbial Ecology profile (google it).

            The nice thing is that when they detect a pathogen, you know it’s there.

          • Paul, Thank you for taking the time to respond and point me in a direction. No one likes to think there’s unwanted critters lurking around inside 😯

            Do you recommend avoiding raw fish(sushi)? For the risk of pathogens?

          • Well, there is a risk. We don’t have sushi often but we do eat it. Freezing kills some of the pathogens.

  3. Thanks Michael and Heidi.Unfortunately, any sort of carbs (including rice and sweet potatoes) are trigger foods, so cutting down gradually hasn’t worked. My main trigger foods are bread and milk, but will look for anything ‘carby’ or ‘sugary” when needed. Thanks for the tip about meditation – I haven’t been able to get into the habit and by the time I need a ‘fix’, am too wound up to sit still for meditation. I am usually stressed as well and trying to get work done so need a ‘quick’ fix to be able to get work done. I also think I am starting to get signs of ulcerative colitis, but even the thought of worsening health doesn’t deter me when the cravings hit.

    • My feel is that if you are very active, then maybe your body is just calling for sugar as fuel I mean. I remember once working very hard at the gym and decided to have a banana when I got home. I ate 10 bananas in one go 🙂 And absolutely no strange symptoms.

      With your situation, colitis, I think personally, you should be eating human foods only and controlling inflammation with getting the omega quantities and ratios right.

      Eating freely a wide range of good human foods is the way to go imo… fruits, vegetables, some soaked nuts/seeds (not to many) lots of fish, and ruminant meats, not too much chicken. Liver once a week, eggs, etc.

      I mean… you gotta start with the big stuff… get grains and dairy OUT and fix inflammation. If you need quick energy, imo, mango, bananas, figs and grapes are great to replace glycogen.

      Generally, controlling carb/protein and therefore insulin, can get you into fat burning mode. So… meals as traditionally eaten… protein with natural fat, few potatoes, vegetables, broth, and a piece of fruit… hormonally is about spot on.

      To sum up… get bread and milk OUT, eat more fish and less chicken, eat traditional meal portions to control insulin, and get glycogen replenishment from bananas… after all, all those tennis players munching bananas can’t be wrong 🙂

      • Michael, I appreciate your input and anything else you care to add.

        I’m active, but not ‘very active’. I’m a bit confused by what you mean by “human foods” If it’s the list you provided, that’s what I eat except now I’ve added in rice and sweet potato.

        I’m off of gluten and pretty much off of dairy.

        One meal ‘type’ that I eat that completely satiates me and makes me feel good are sushi rolls. (rice, salmon, avocado, seaweed).

        Controlling portions IS the answer but I feel like I’m starving (especially in the evening)Willpower works only in the short term

        Ulcerative colitis is indeed an inflammatory disease, but it is apparently auto immune in nature.

        I will try to increase the bone broth and also the fish (I have affordable access to pasture raised beef but fish is expensive!). For liver, I swallow pill sized frozen pieces because I can’t handle the taste.

        • Hi Heidi, I think PHD has some good info on balancing the fats… getting the right amounts of fish vs lamb/beef etc, and getting the PUFAs right. I think this is essential.

          I don’t know much about salami but I’m not a fan of cheese 🙂

          I would cut back on the fat til you are at your optimal weight… a palm sized portion of lean protein, about 3 oz of white rice or sweet potato etc plus as much non starchy veg as you like plus a fruit starter (or save for a snack). Then about 1.5 tsp olive oil and lemon juice, or some broth. That’s about what you need for each meal. Then have fruit for snacks or a small handful of soaked nuts like macadamia, almond, walnut. Or veg crudites with guacamole. Brekky have some fruit or a veg omelet.

          At this amount, see how much weight is dropping each week. If you’re not losing, them adjust the portions slightly — so you are very clear about the volume of food in your day.

          The key for weight loss is structure… to know exactly what you’re doing and the result that is having.

          As I say, with the right hormonal response due to the macro ratio of meals, you prob won’t be hungry and you’ll be burning body fat. If you do need a “fix,” try a banana, a couple of dates, a few grapes or half a mango.

          It really help to keep a food diary and to keep your daily structure constant to lose body fat. I.e. today it’s an apple, tomorrow a pear, today it’s rice, tomorrow, sweet potato… the same types of food, the same quantity. Then you have solid feedback with your diary and scale reading.

          • oooooooooo just had a thought about why you feel you need a fix. It’s a well known fact that when losing weight, one loses water as stored carbs are used for fuel. So I imagine, dieters have pretty LOW glycogen stores. And if you’re very active, this could lead to major binging on carbs!! It all makes sense, to me anyway 🙂 So the trick is to stay hormonally balanced to access body fat, and replace glycogen if you’re desperate with those fruits I mentioned. I’m 99.99999% sure that’s gonna work for you 🙂

          • Maybe this is the reason why so many diets fail — dieters are constantly “hitting the wall” like runners do when they run out of glycogen. It’s very unpleasant. And like I say, once you train your body to burn fat, you’ll be fine, by eating the right ratio of carb/prot for each meal like I said and in the meantime, top up glycogen as needed with sweet fruits. Yay.

            Once you have your target body fat%, you can eat fattier meats smothered with butter, and have a few more carbs as well but not many more — the right kinds of course 🙂 I reckon that’s perfect.

            Paul’s level of carbs is about getting this right… but personally I would swap some of that 1 lb of safe starch for fruit, as I said about the “traditional” meal ratios.

          • “Brekky have some fruit or a veg omelet.”


            Brekky have a piece of fruit AND a veg omelet.

        • Human foods are fruits, vegetation — roots, shoots, tubers, bulbs, flowers, leaves, etc. Nuts/seeds, meat/seafood/eggs. I reckon if anyone is sick, the safest thing is to avoid all non-human foods. Simplistic, yes, but it works because one automatically avoids 99% of the problems by doing this.

  4. Hi Paul,

    Congratulations on the book deal! I have a question for anyone here about food sensitivities. I had a blood test which resulted in 32 different food sensitivities! The thought of eliminating them all is daunting, and I’m wondering if it’s even necessary to put myself through yet another restrictive regime that may or may not even help. Is it possible to heal a leaky gut and immune issues with the PHD/supplements and addressing infections alone, or is it necessary to do a whole elimination diet as well? Any comments would be greatly appreciated. Thanks.

    • Hi Andrea,

      It’s a situation where you have to bootstrap yourself.

      When the gut is leaky everything can excite a food sensitivity, so you usually end up with many sensitivities. If you remove them, then the gut can heal faster (less inflammation), but you risk malnourishment and it’s no fun. Also, you’ll probably develop new sensitivities to the things you replace them with.

      So I would eliminate the ones that actually create allergies (eg egg whites, nuts, etc) but keep eating foods that aren’t known to generate allergies.

      However, I would try to find a mix of foods that gives you minimal problems, yet is well nourishing. Sometimes pure glucose/dextrose may be the best source of carbs.

      Best, Paul

  5. I posted on here a few weeks ago as a long time migraine sufferer (chronic migraine 16 years) and ulcerative colitis, as well as some platelet fluctuations. 6 weeks ago I eliminated all packaged food, alcohol and 2 weeks ago I eliminated gluten. Since eliminating gluten I have not had a single headache. That is truly amazing!! Since I have given up so much so quickly, I am going to give my body a few more weeks before I change anything else. I live in NY and let me tell you, giving up bagels and bread is really hard! Just wanted to post something I am so proud of and I am feeling a lot less sad!!

  6. Hi Andrea, I don’t claim to be an expert by any means but I’ve got a vague memory from a while ago that we have similar problems. My take on the food sensitivity issue is, firstly, that I’m not sure how accurate any of those tests are. Secondly, food sensitivities come and go when there are complex underlying issues, which probably always include leaky gut, amongst other things, so you could do the same test tomorrow and get a different result. I would suggest that you avoid eating anything that you know for sure makes you feel ill and concentrate on healing your digestion.Which is a lot easier said than done I know, but you just have to allow a lot of time. Good luck, I’m in the same boat.

  7. Hi Paul — If you have covered this elsewhere on the site, please point me to it, as I can’t locate it. Can the PHD act to balance hormones, specifically regarding menopausal hot flashes? Thanks!

    • Hi Kathy,

      I’m afraid I haven’t discussed it, because I don’t have much knowledge about that.

      However, I tend to think that the same diet and lifestyle practices that work against other disorders will help with hormonal imbalances.

  8. Paul, Terry Wahl recommends abundant plant sources of sulfur. I didn’t see a discussion of sulfur in your book. I did see a reference in the blog to getting enough sulfur through sources such as eggs, garlic and onions. Is that enough sulfur? I realize that Dr. Wahl’s diet is directed towards multiple sclerosis, but she seems to recommend it for general health. PHD says eat vegetables as much or as little as you like (which is a recommendation I like because let’s face it, vegetables in excess are not delicious). What are your thoughts on adequate levels of sulfur relative to Dr. Wahl’s recommended diet? Thanks

    • Hi David,

      I don’t know how much sulfur is optimal. Too much can fed sulfur metabolizing gut bacteria which you don’t want.

      Stephanie Seneff has argued that places with high sulfur soils are unusually long lived, but I haven’t been able to find solid data on that.

      In diseases like MS I recommend supplementing NAC or glutathione, which are sulfur-containing antioxidants which work great against infections.

      The Wahls approach is intriguing but mechanisms by which benefits occur, risks, and in what people the benefits may be expected are all fuzzy or unknown.

  9. Does anyone know of any tricks to search old postings on the Q&A forum? Questions that I posted a few months ago do not seem to show up in my searches. I have tried both the google custom search window at the top and the PHD search window just below it.
    Thank you!

    • another way to search old stuff, is to use the web feeds.
      Either subscribe to the ‘Comments Feed’ to get all comments or the ‘Q & A Comments Feed’ for just Q & A comments.
      Then you can use the search function in your web feed reader.
      Does the trick for me….i use Google Reader as my webfeed reader.

  10. Ouch, looks like Google doesn’t index older comment pages :-/

    You can do a search like “site:perfecthealthdiet.com bsg” but that only shows that you wrote a comment on June 3rd. Doing some manual searching then gives http://perfecthealthdiet.com/q-a/comment-page-24/#comment-80533

    This wouldn’t happen with a forum 🙄 😎

  11. Hi Paul and Shou-Ching,

    I thought your book was brilliant and purchased it after Chris Kressers recommendation on his site.

    I do a lot of Weight Training and sprinting and have implemented your recommended way of eating fully. The only thing is I have found I am struggling to maintain weight. Is it ok to make up the extra calories I need by consuming more coconut oil? I cook with Ghee, Coconut oil, Lard etc but am still not getting enough calories.

    I am looking at adding an extra few tablespoons of coconut oil (Virgin organic of course) either on its own of in cups of green tea.

    I assume thats ok as I dont want to ramp up my carbohydrates too much.


    • Hi Martin,


      Carbs would work better than coconut oil for gaining muscle mass. I’d say about 30% carbs 20% protein 50% fat (but very low in PUFA) is best for muscle gains. Overeat total calories after a workout, undereat on rest days.

      There’s nothing wrong with eating more coconut oil but by itself it’s not great at triggering weight gain. It’s the proportions that matter most.

  12. Hi Paul-
    And if one was wanting to gain muscle mass and drop body fat, would those ratios stay the same (30C/20P/50F)but without the overeat and undereat?


    • The overeat after exercise adds muscle, and the undereat on rest days drops body fat. So those are important ingredients. Yes, just eating 30C/20P/50F will give you a good body composition without overfeeding/underfeeding, but if you really want to be cut you would need to incorporate that too.

  13. Thanks Paul. I have been doing PHD several months after going VLC while doing Crossfit 2-3 times a week. I had almost all of the glucose deficiency symptoms and was ” hitting the wall” halfway through my Crossfit workouts. Within a week of starting the PHD, all symptoms disappeared and workout performance increased. I still want to decrease body fat (20 lbs) and build muscle mass. I am convinced PHD will show the way….just wondering how much tweaking is necessary. Thanks again for your work….looking forward to your new book.

  14. Hi Paul,

    I wanted to thank you – I have been following PHD for a little over a week, except that I did not eat any fruits, rice or potatoes. In just one week, I lost 8 pounds of fat and gained 4 pounds of muscle. Even better, I lost all my cravings for sugars/carbs, and I used to have really bad cravings! I am exercising again, so I added sweet potatoes and mixed berries in my diet. But, I’m not sure how much to incorporate. I do one hour of cardio 5 to 6 days a week, and one hour of weights 3 days a week. Do I still want about 300 calories a day from carbs?

    I also have a question about raw milk and other dairy – should I count any of the calories from milk and dairy in my total carb calories for the day? I know that we don’t count carbs from vegetables, but I was not sure how to treat carbs from dairy.

    thank you so much!


    • Hi RO
      Well done on the fat loss, its what i’m striving for and I’m keen to know the specifics of your daily food choices per meal, please can you send me what you ate over the past 10 days >?
      You can email me if you prefer on rhatter@gmail.com

      Thanks a lot !
      Hong Kong

      • Hi Ricardo,

        A typical breakfast for me was 1/2 cup of raw milk, 2 egg omelet w/ 1 tsp of raw cream and 2 or 3 slices of beef bacon.

        For lunch and dinner, I usually had a bowl of beef bone broth soup, w/ green veggies (kale, collard greens, etc.) and Shirataki noodles, and either steak, lamb or chicken.

        For snacks, I usually had cauliflower, brussels sprouts or broccoli w/ coconut oil, 1/4 cup macadamia nuts or raw almonds, raw cheese, or boiled eggs w/ sliced tomatoes and guacamole.

        The best thing was that I felt full and I did not feel deprived at all! Now that I am exercising, I have a whey protein shake w/ raw milk and almond butter for breakfast, and 1/2 a baked sweet potato right after my morning cardio and another 1/2 of a baked sweet potato with dinner. I’ve also added mixed berries w/ heavy cream for dessert.

        Hope this helps! Good luck


        • Hi RO,
          Many thanks this is really helpful I cant get RAW milk and raw cream in Hong Kong there are no cows here !…, do you know the total cals ? and how many ounces of either steak, lamb or chicken.

          thanks a million !

          • Hi Ricardo – I don’t know the calories. I was eating about 4 to 5 oz of steak, chicken or lamb with lunch and dinner, but I am a girl so you would probably eat more. The cool thing about this program is that I really just ate when I was hungry and stopped when I was full – and I never did that before.

          • Riccardo, don’t feel bad. I can’t get raw milk or cream here in Florida either and there are gazillions of cows around.

          • This message is to erp — I live in Florida myself, and I can get raw milk and cream. If you do a search on realmilk.com I’m sure you can locate some.

          • Thank Kathy, I’ll investigate website.

  15. how in the hell do you get the 50% fat-30% carb-20% protein
    can you give me some real food – meal examples for B, L D

    • I aim to stick to 65% fat, 20% carbs, 15% protein. For example, today I had:
      Bkfast- 2 rice cakes spread with coconut oil, mashed banana and cocoa nibs. Mug cocoa with double cream.
      Lunch- Large salad with tin of mackerel, cottage cheese and a little olive oil.
      Dinner- jacket potato wedges baked with a little butter and melted cheese, 2 duck eggs scrambled with creme fraiche, butter and pepper. Mug cocoa and 2 squares 90% cocoa dark chocolate.
      Using Fitday.com the day’s intake came to exactly 65/20/15% (just over 1730 cals).
      I didn’t have a lot today as not too hungry but normally I have a meat based evening meal with lots of veg, some rice or potato. I cut back on protein during the day if I know I’ll be eating a fair amount of meat/fish in the evening.
      After using Fitday for ages I can more or less get the ratios right every day without thinking about it too much!

    • I would also like to recommend http://10minutemeal.com/ Really, this site has changed my life. I don’t know how PRECISE the macronutrient ratios are. I’m going to start tracking some of the meals so I can find out. But the menus are based on PHD, and I just love them. The site has really enhanced our lives. Seriously.

  16. But Mark counts vegetables as carbs whereas PHD doesn’t.

    • my take is that PHD does count carb calories from some vegetables; ie. tubers, corms, sugary vegetables, fruits, or berries.
      Here’s an old comment from Paul on the topic;
      “It takes about 40 calories of glucose to digest a pound of vegetables. Leaf vegetables have less than that and so are negative contributors to glucose balance. But most squashes, root vegetables, etc have more than that, often around 80 calories per pound. Carrots are around 200 calories per pound, beets even higher. Potatoes closer to 400.

      So, a simple way would be to subtract 40 calories per pound from everything. Another way is just to ignore most vegetables that are not “safe starches,” tubers, corms, sugary vegetables, fruits, or berries.”

  17. From the page……Totals
    Let’s take a look at the totals. If I ate all three large meals and the snack and the berries and the wine I’m still just over 2,500 calories. Truth be told I rarely eat all of this in a single day; unless I’ve been especially active.

    But what we are really interested in is the carbs. This sample menu came in at 115 g of carbs which leaves us with plenty of wiggle room. This is the take home message: You can enjoy copious amounts of fruits and veggies and still never crack 150 g. It’s important that you let that sink in. What this means is that you don’t have to count carbs like I have done here if all you are trying to do is maintain your body composition. Even if you are attempting to speed up weight loss by keeping your daily carb intake to below 100 g you can see that it can be done with very little effort or thought as long as you stick to nuts/seeds, fruits, veggies, and meat.

    Read more: http://www.marksdailyapple.com/primal-blueprint-sample-menu/#ixzz1xXzPWEPT

  18. http://www.blogtalkradio.com/undergroundwellness/2012/01/20/perfect-health-diet-with-paul-jaminet-phd

    Paul Jaminet, stops by UW Radio to discuss how you can consume a diet that gives you all of the nutrients you need to optimally nourish your body while minimizing dietary toxins:

    Perfect Health Diet with Paul Jaminet Ph.D. 01/19 by Underground Wellness | Blog Talk Radio

    Great podcast.

  19. Hi Paul —

    I remember you said you eat conventional meats — does that apply to organ meats as well? My grocer is selling beef hearts for $1.99 a pound and I would love to take advantage of that, if indeed conventional organ meats are safe. Also, do they lose important nutrients (specifically I’m looking for CoQ10) in cooking?

    Much thanks in advance for your reply!

    • I think for liver you should always get organic meat, but for heart conventional is probably fine. Grass-fed beef hearts go for $3.99/lb in my neck of the woods.

  20. Hi there Paul!
    Just wondering, would the PHD be effective for healing a leaky gut/and EXTREME dog allergy that manifests as a skin rash? Been paleo for 2 months now and have not noticed too much of a difference.

    • It will typically improve allergies but healing a leaky gut is slow (new insults every day) and allergies are tough to cure if the dog stays around.

      Some things that help: drink lots of water; extra vitamin C; vitamin D optimization.

      • What do you mean tough to cure if the dog stays around? Surely it would get better after a lot of frequent exposure?

        • I meant it would be hard to eliminate the allergic symptoms if the dog stays around.

          An allergist could advise you about the best ways to make the allergy go away. But my guess would be that inflammation from the allergy might hinder the gut recovery that is necessary to eliminate the allergies.

          • George Henderson

            My wife developed serious asthma when we got a goat, took prednisone for a short while, got better, no longer reacts to the goat at all; so not all animal allergies will persist over continued exposure.

  21. Real Food Eater

    Hey Paul,

    I saw the french fries recipe on your blog and it looks delicious. However, one thing I have been wondering is how healthy are foods fried in healthy oils (like beef tallow, lard, butter, ghee, coconut oil)? These oils have very high smoke points, so it seems like the food will be fine as long as you stay below the smoke points. Also, healthy, traditional cultures would fry foods, so based upon common sense it seems fine.

    Also, I found two recipes that could be easily modified to be Perfect Health Diet compliant: fast food style hashbrowns-http://www.youtube.com/watch?v=m8hA7L6v7zo and KFC style fired chicken-http://www.youtube.com/watch?v=PTUxCvCz8Bc&feature=relmfu. In both cases, you would just switch to rice flour and a healthier oil.

    Finally, could you please post a PHD compliant pizza recipe? There are few good ones online.


    Real Food Eater

    • Hi RFE,

      Yes, frying is OK if all the ingredients are good, but you should still try to keep cooking temperatures low. Some toxins start forming at temperatures as low as 240 F.

      We’ll work on a pizza recipe – we actually made a PHD pizza a few weeks ago, but the recipe needs refinement – but all you really need to do is substitute a gluten-free flour made from rice flour, potato starch, and tapioca starch to make the dough, and use PHD approved ingredients elsewhere.

  22. i want to achieve six-pack abs but i want to know what if i follow the low fat paleo diet instead you eating more fat. i will also eat low carbs.

    i know you have to eliminate processed food( bread pasta, rice, cereals etc..)
    so by just eliminating these processed food would i lose belly fat quickly.

  23. These may be classic “low-carb flu” symptoms but in the nearly 2 weeks since I started cutting back on carbs, I’ve been waking up every morning with anxiety and depression and these are not conditions I have suffered from historically. My wife has even pointed this out, suggesting that the change in diet has also brought about a change in mood/personality (i.e. “you’re not the man that I married”)

    I know irritability (which I have too) is a classic trait but the overwhelming anxiety (“what can I eat today?” “what’s in the pantry that I can/cannot eat?”) and depression (“my life has no pleasure left”) is something I don’t see discussed as much. And having spoken to personal friends who went on this diet, they also reported irritability but not anxiety or depression.

    At first, I thought this was mostly “in my head” but it’s clear to me that part of the dimension is also physiological in nature. Whatever is happening in my body is definitely having an impact on my psychological state.

    I’ve read that a low-carb diet – and to be clear, I am not zero-carb though I’m less carb than the PHD diet calls for – can prompt the body to increase its production of cortisol and that this may explain my mood changes?

    Your thoughts Dr. J?

    • I should add: I’ve also been losing weight (~2-3 lbs a week so far) so I’m assuming there’s some kind of caloric shortage that’s happening. Could that also account for my mood swings?

    • Hi LB,

      Well, you say that you’re “less carb than the PHD calls for” and the carb reduction is giving you trouble. I would think the obvious solution would be to add carbs; and that would bring you more in line with our diet.

      Depression indicates a flare of inflammation so you may need to improve your gut flora, or you might have some eukaryotic (protozoal, fungal) infection that is worsened on a ketogenic diet. But so many things can cause it, it’s hard to diagnose based on depression. You might want to get a stool test, see if anything turns up.

    • Irritability, depression and anxiety are all affected by brain/gut serotonin levels. Try eating your safe starches separately, with no protein and little fat, for a mood boost in 20-30 minutes.

      Low-carb can be an emotional disaster for
      some people — that would be me, too!

      Holly, a retired psychologist

      • Holly: thanks for this. I should have added though, I’m prediabetic so I’m trying to mediate any kind of glycemic response I might incur. To that extent, I have been mixing starch with protein and fat (as per PHD suggestions).

        And I do feel better after any meal. It’s between meals (such as waking up after a night’s sleep) where the anxiety/depression is at its worst.

        Dr. Jaminet: I’ll try to up my starch intake and see if this improves an overall mood and I’m already supposed to see my doctor on Tuesday so I’ll ask if a stool analysis is possible.

        Question though: if I had a pre-existing eukaryotic infection, what would my likely symptoms have been before I went low-carb?


  24. is eating 150g of protein, 90g of fat and 150g of carbs per day seems to be ok should i change something.

    2100 Kcal per day.

    i am 19 and i do lots of training at gym.

  25. Hello Paul. I have been reading “The Mood Cure” by Dr Julia Ross, which has a lot in common with PHD. There are some differences, and I would be interested in your thoughts on her recommended supplements of Glutamine and Tyrosine. Thanks for your time/thoughts.

    • Hi Caroline,

      I prefer getting amino acids from food rather than supplements. As far as those two go, they could be good or bad. Both can promote bacterial infections. Tyrosine can support thyroid function and glutamine can support intestinal function.

  26. Real Food Eater

    Hey Paul,
    To prepare for basketball and getting in shape, I just ran a mile. A huge problem that I had is that I suffered from severe cramps on my ribs; this has been going on during my runs for years and it is why I hate running. I looked up this problem online and got the advice to control my breathing, but it didn’t help one bit. No matter what, I cramp every time I run and it is very concerning to me. Do you think I have any physical problems? How should I solve this?
    Real Food Eater

    • If what you’re getting is a stitch in your right side, it comes from compression of the liver and results from the timing of your footfalls — the right foot hitting the ground during an exhalation. Just exhale when your left foot hits the ground.

      If that’s not it then I don’t know what’s going on. I haven’t heard of cramps on ribs. If it is a muscle spasm you might try magnesium supplements, magnesium, potassium or other electrolyte deficiencies are common causes of cramping / spasms.

    • check out pyroluria: one of symptoms is stitch in side when running. I had forgotten about that when reading the list of symptoms – had that as a child when late and running to school.

  27. The cardiologist visit resulted in learning that my heretofore “functional” heart murmur is not functional (outside the heart), but a result of a deformed aortic valve. Since I’ve never had rheumatic fever, doc believes it was a birth defect. Says that it is only slightly calcified, and blood flow through the valve is good. Suggested that I should get an echo every 5 years, and probably won’t need to think about valve replacement for another 20 years, as long as I do not manifest the symptoms of concern: chest pain on exertion, blacking out, shortness of breath on exertion. Very weird to learn of this so late in my life. Probably a gift to my younger days.

    Unrelated note: Here is a possible positive from mostly PHD diet since November. As a young mother I learned that our tongues reflect information about our health. No matter what I did I could not get rid of the dividing line down the middle of my tongue. Also, the edges were scalloped from resting against my teeth. Then, ten or so years ago, I noticed a spot toward the front of my tongue where the taste buds showed a crater, of sorts. Long ago decided that it was the way of things with me. However, just this week I noticed that the division down the middle was much less severe and shorter and the “crater” is less severe, and the scalloping seems gone or greatly reduced.

    I say “mostly PHD” because I have not developed food prep habits to easily incorporate veggies frequently. I’ll work on that as I get into more time that summer affords me.

  28. After my brother’s testicular cancer surgery I supplied him with vitamin D and vitamin K (LE). He has been going in for blood tests since surgery the 1st of March, and was recently found to have an elevated liver enyme. Number was 81. Top of the normal range for this one is 51. Doc told him to go off the vitamin K. He did and a week and a half later that enzyme level has dropped to 52.

    I was hoping K would be a help, not a problem. Does anyone know about this connection with elevated liver enzymes?

  29. George Henderson

    Vitamin K3 will raise liver enzymes; this is a synthetic form of vit K, a precursor of K2.
    The liver converts some K1 to K2 via K3, but only minute amounts of K3 should be formed briefly in this process. I haven’t heard of vit K apart from K3 being hepatotoxic.
    (for example, http://www.livestrong.com/article/547706-vitamin-k-elevated-liver-enzymes/)
    But if the doctor diagnosed it correctly, maybe there is something to it. Perhaps you should ask the doctor why they suspected the vitamin K, and check for K3 (menadione) in the product.

    • Thanks, George. Henderson was my dad’s middle name.
      The K2 I gave him is Life Extensions, and label indicates only K1 (phytonadione 1000mcg)and K2 (menaquinone-4 100 mcg and menaquinone-7 100 mcg). I believe this is the one that the Jaminets take. Seems I read that Paul takes one every other day. Doc told bro that there are other possibilities, such as taking a while to come down from surgery anesthesia. I read something online that abdominal surgery can elevate those enzyme numbers for a bit. They did go in through his left side. Doc said they won’t worry about hepatitis until number reach 150-200.

      Thanks again, George. I’ll send your remarks to my brother.

      • George Henderson

        I believe that injury and haemolysis can give false LFT readings because other cells, including muscle, contain some of the same enzymes as liver cells. So anything that produces heavy bruising, like surgery, could release extra enzymes, from memory mainly ALT, until one recovers. And anaesthetics can definitely hit the liver.

  30. Real Food Eater

    Hey Paul,
    I know that you discuss grains as being toxic (with the exception of white rice), however their toxicity is greatly reduced through traditional preparation (soaking, sprouting, grinding, thoroughly fermenting, and cooking). Therefore, what would be your view on a highly fermented sourdough rye bread? Rye has high levels of phytase, so through fermentation phytic acid can be reduced to levels of nearly 0 (http://www.westonaprice.org/food-features/living-with-phytic-acid). Rye to begin with has lower levels of gluten than wheat, and sourdough fermentation has shown to reduce gluten levels; this Italian paper on controlled sourdough fermentation looks promising: http://www.ncbi.nlm.nih.gov/pubmed/17513580?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum. They were able to create a bread with such low gluten levels that celiac patients could tolerate it. Through careful preparation, may sourdough rye be considered a nutritious food?

  31. Regarding what Paul and Shou-Ching say in the book about cream —
    On page 168 it states: “Cream has about half the protein per glass as milk.”

    While on page 246 it states: “Paul, who doesn’t care for the taste of coffee unless it is heavily diluted, drinks coffee mixed with an equal amount of heavy cream. Since the cream provides fat calories only, it doesn’t interfere with the fast.”

    These two statements seem contradictory and I have not had success finding clarification in searching the PHD blog. I used to make butter with the raw milk we purchased years ago and there was always a measureable amount of skim milk after I took out the butter. Surely this was a protein containing milk. Before churning out the butter the cream must contain protein.

    I am just trying to get the mechanics of the daily fast down. I have suspected the cream amounts to cheating and, thus, compromises the fast.

    Is there something I’m missing?

    Thanks 🙂

    • Hi Dale,

      Sorry, there are some protein calories in cream, also in butter.

      But the overwhelming majority of the calories are fat.

      So the protein content mainly matters only to those who are sensitive to dairy protein.

    • See also http://nutritiondata.self.com/facts/dairy-and-egg-products/51/2 , only 2% of heavy whipping cream is protein. There’s also 3% carbs/lactose and 58% water 🙂

      You can also put butter or coconut or MCT oil in your coffee, if you blend it it stays homogenous for quite a while. I like the taste but I don’t bother with the blender, just a scoop of butter or coconut oil and stir.

  32. Hey Paul,

    I have been following a primal/paleo diet for a while now, but only about a week ago started a PHD. Now the only problem that I really have is acne. I have never been able to gain an ounce of fat in my life and have always been athletic/in good shape, so the only reason I started eating healthy was in an attempt to cure my moderate to severe acne.

    • Ah, sorry about that. My acne has been clearing up, but I don’t know what to attribute that to. Anyways, I was wondering if I could get some feed back about my current diet. I feel fine, but just want to make sure that it is okay health wise. At 6:30 am I will either eat 8 oz of egg whites or 4 eggs, and a vitapril multivitamin. Then at 9 I eat 1/2 cup of white rice with 1/2 a stick of butter, 1 TB of sea salt and another vitapril multivitamin. At Noon I eat 1/2 a head of lettuce, 5 leaves of spinach, 1 leaf of kale and either 8 oz of egg whites, a chicken breast or 1/2 lb of grass fed ground beef. Then at 2:30 I eat 1/2 cup of white rice with another 1/2 stick of butter and 1TB sea salt. Then at 5ish I will eat 1/2 a head of lettuce, 5 leaves of spinach, 1 leaf of kale and maybe 2 leaves of collards. Then at 8 I will eat 1 lb of sweet potatoes (jewel yams) and 1 stick of butter. And that pretty much sums up what I eat in a day. Now this gets me through the day, but I could easily eat twice that amount because I am always hungry and have always eaten a lot. So I was wondering if this was an okay diet plan to keep following. In the future I will be substituting the 1 stick of butter that I eat with the white rice for like 1/2 cup of coconut oil which I would normally use, but I ran out recently. I am also going to start consuming some kelp/iodine pills, and some extra vitamin c pills. Thanks for any input! -R.S.

  33. Real Food Eater

    Hey Paul,
    I just recently took up your advice and tried a PHD approved pizza; it turned out wonderfully! I adopted it from this recipe: http://comercomojuan.wordpress.com/2011/05/25/pizza/. I modified it and only used white rice flour with no xanath gum. It had a remarkable texture, held up quite well, and had a light, crispy, amazing taste! If you want pictures of the pizza, I could post a link in a future comment.

    Secondly, on the subject of food reward, I do not buy a couple points. Firstly, I don’t think that diets low in reward are very healthy because they tend to be high in one macronutrient (either proteins, fats, or carbs). They can therefore lack the essential nutrients/vitamins that the body needs. Take Ban Chan, Thailand in the 1950’s; 80% of their diet came from white rice!!!!!!! Though their diet was low in reward and they were lean, some had vitamin B and calcium deficiencies (you can read more about it here: http://www.westonaprice.org/traditional-diets/thailand-land-of-coconut). It seems that many healthy cultures strived to make their food palatable, and I would find it very odd if they did otherwise. I agree with your point that its the quality of the food, perhaps not the preparation/reward of the food, that is what’s important.


    Real Food Eater

  34. hi All,
    Anyone know if there are any human studies/research on whether Sucrose consumption lowers ACTH (the main pituitary stress hormone)…or human studies/research on whether Fructose consumption lowers ACTH.
    I found some rat studies on the subject, that seem to show that sucrose consumption lowers ACTH in rats, see here for some info and links;
    But no human studies.

    The closest i could find was on Glucose;
    which had no effect on ACTH in humans.

    (ps. i just posted same question under
    but realised it may be better to ask here, as more people will probably see it? )

  35. Paul, I´d like to inquire about calorie restriction and longevity. Does calories restriction in general have a (positive) influence on life span or is it just the protein restriction that counts? For me, restricting calories and dropping weight would put me into the underweight categorie and I am concerned that this wouldn´t be healthy. Does calorie restriction have an advantage over protein restriction alone? Is it, in the end, not healthy to have a fast metabolism and burn a lot of calories through activity? Is a slow, effective metabolism (as seen in long-term dieters and anorexics) in the end healthier? Thank you!

    • Hi IG,

      You don’t want to lose weight, you don’t want to eat a healthy balanced diet that minimizes appetite. PHD is designed to do that.

      Intermittent fasting at normal (but minimal) calories is best. You should not be hungry.

      Activity is good, yes. No, a slow metabolism is not healthier; a normal metabolism is best.

  36. Oh, just an addition: Is it actually good to have a slow metabolism/low thyroid (research by Joel Fuhrman) and that it contributes to a longer lifespan? I am on thyroid medication (and thanks god my metabolism seems to work well) but I wonder if I would be healthier with lower thyroid function? All this confuses me…

    • Centenarians tend to run about 0.1 TSH points higher than normal people, but are still in the healthy range, close to 1.0. They’re certainly not hypothyroid. Usually it is a genetic difference, it’s not clear that without the genes, elevating TSH by 0.1 would increase lifespan.

      If you’re hypothyroid, you should try to get as close to normal as you can.

  37. Hi Paul,

    I’m wondering if you eat raw oysters?


  38. Hi Paul and fellow Paul-readers,

    Can anyone think of a common cause for these two symptoms:

    * Slow recovery from minor cold / flu episodes (3-4 weeks to get back to 100%, as opposed to the 3 – 7 days I see around me).

    * Inability to gain strength / muscle despite following tried and true strength training protocols.

    Diet background: I have been experimenting with Low Carb / Primal / Paleo / PHD diets for more than two years now. I have put a lot of effort into all of this but sadly only with marginal results. I am running out of things I can try so that’s why I am throwing this out there…



    • George Henderson

      Low vitamin D levels (or sub-optimal) would account for the former.
      (also, try elderberry extract for the ‘flu next time, and zinc lozenges – inorganic salts – for cold).

      The second could be genetic. I doubt everyone is meant to bulk up the same. But also look at hormone levels; testosterone, DHEA.

      • “I doubt everyone is meant to bulk up the same.”

        Think army… 1000 new recruits, same drill, same results. Human bodies respond the same unless there is some medical issue, which is why if David is overeating and not gaining he should see a doc, otherwise, overeating and heavy training are the magical combination. I’ve never seen it fail.

        “But also look at hormone levels”

        Yeah, look at your hormones when you overeat, they go ANABOLIC 🙂

        • George Henderson

          The army won’t take you if you’re F4. And where do you think they get all those clerks from?

          • ahahah well I guess they’re like the guys in the gym I met who have a piece of toast for breakfast and a satsuma for lunch and expect to pack the pounds on by working hard 🙂

            Seriously overeat by 250-500 cals and do splits… hard, and if you don’t gain muscle and weight, I’ll eat my hat, and you can say I was wrong, and I’ll hold my hands up. Don’t deny it, til you try it 🙂 David wants to gain, he “put it out there” so that’s my solution, have your beefy muscle or stay skinny… up to you 🙂 It works. 🙂

        • I have no trouble gaining weight but the trouble is it won’t be muscle :-(. I am thinking about a possible underlying medical issue (which is why I was trying to find a link between gaining strength and recovery from cold/flu) and I have seen doctors about this. Unfortunately they’re so unhelpful that I feel forced to figure this out myself. My vitamin D levels are fine and I have had my testosterone levels tested (which I had to BEG my doctor for). I’m not entirely sure DHEA was among the hormones tested though.

          • How do you know you’re not gaining muscle? Overeating means you gain fat and muscle and then you have to do fat loss, so it’s two forward one back. One thing I notice when overeating was how much energy I had to train, which I attributed to “full bags” (of glycogen). Quite amazing, the difference. Do you have a scale that measures body fat? That way you can do this — tentatively if you like (try +250), for a month, and take measurements. That will tell you if you have gained LBM. Or if you go to a gym, they will do skin-fold measurements which are more accurate.

            I read an article a while back and the guy mentioned a study where they got guys to gains loads of muscle JUST by overeating and undereating phases, no training 🙂

            Physiologically, I can’t see how your body would only gain fat and not muscle by overeating.

            Are you sure you’re not suffering from “fear of the flab” like those skinny guys I knew in the gym 🙂

          • Hi Michael, thanks again for your comments.

            You are right: I do have a ‘fear of the flab’ but I have conciously tried to let this go of this during my strength training experiments.

            I know I could not have been gaining a significant amount of muscle because my performance did not improve beyond the first few weeks (where the improvement is mainly neurological i.e. learning how to do a movement results in better performance without needing extra strength). Simple example: in week 2 I would do 3 x 8 push-ups (pathetic, yes I know), three weeks later (despite practising this three / four times a week) this amount would still be as challenging as before.

            I’m okay with not having huge muscles but to do strength training and not gain strength is just too frustrating.

          • Hi David, “fear of flab” and “fear of pain” is also an issue. You definitely want to be training to failure… provided you are already well conditioned of course.

            Check out Bill Philips body-for-life workouts, I think they are great, simple split and uses a combination of pyramids and supersets to safely get you to failure.

            The more conditioned you are, the more you can get away with hurting your muscles once you hit failure, for example, keep dropping the weight and going to fail again, drop and go to fail again, etc.

            If you’re not attempting something you can’t do, there’s little reason for your body to change.

            Also… figure out a typical day’s food to get you into the calorie ball-park you need so that you have a clear map of your diet day.

            If you ain’t pulling funny faces, you ain’t working hard enough, and if you ain’t gaining weight, you ain’t eating enough. You have to get these things working for you.

            And no cardio except sprints (after a warm up). Get really clear about what you need to do diet and training wise and then do it for a month, see what happens. If no joy, then your doc HAS to listen cos you have the calorie and workout data (yes, log it).

            Don’t worry about flab, it’s so easy to get rid of by tightly controlling carbs/prot and cutting the fat right back, once you want to get lean again. Or you can start by getting very lean and then bulking, which would still mean you stay in the lean category.

          • Oh I should say… I don’t know anything about you, so I warn you… never throw yourself into something you’re not conditioned for, cos then you’ll just get injured or worse. You must GRADUALLY move into the program you want by upping the intensity/ # of sets etc each time.

          • David… write to my gmail: hg.mikk if you want to chat more cos this is off topic for most people. Cheers.

  39. The number one reason for failure to gain is not overeating. I used to work in a gym and I’d see all these guys REALLY working hard and not gaining a pound. You’ve gotta overeat and get adequate protein which isn’t much… 0.8g per pound of lean body mass works for an average amount of training, 1g if you are working REALLY hard. I remember Paul saying overeat on training days and undereat on the other days. That would work nicely I think to keep you lean while growing muscle.

    • George Henderson

      You’re right – try it and see; you can try anything for a month or two.
      Certainly if someone is trying to bulk up while following calorically restrictive ideas about what’s healthy, that’s not going to work.

  40. If you overeat and train hard, especially using split workouts, you can grow REALLY fast… which I would caution against because you can end up with stretch marks that won’t go away.

  41. Just another question to the high/low metabolism: A person at an ideal weight shouldn’t eat below maintainance and try to lower metabolic rate? Do I still benefit from “low calorie days” if balanced with higher calorie days or is it just keeping protein low that is effective? Thank you!

    • I am a strong believer in changing your diet and lifestyle to help with most health issues. I used to wake up exhausted no matter how much sleep I got. I rarely ever felt rested and could easily nap every day. I started to learn that a lot my friends and family wee experiencing the exact same thing. Many of my friends had tried everything, except for diet and exercise, while I was using diet and exercise to help cure my sleep problems. A close friend of mine tried a natural sleep supplement and got some great results from using it. I believe there are some great things out there that can help us, but I really believe a lot of our health issues boil down to our lifestyle choices.

  42. Hi Michael,

    Thanks so much for your reply. I realise I should have phrased my question more clearly to make it obvious that, at this point, I think food is unlikely to be the problem (or the solution).



    • If you’re not gaining weight, you’re not eating enough 🙂 If you’re tracking your calorie intake and not gaining, see your doctor immediately!! Overeating is anabolic, i.e. anabolic hormones are functional in your body. I pondered this overeating on training days only and then I remember how for me, it took about 4 days before I could comfortably eat about 2700 calories a day. It was TOUGH to get down at first but after 4 days… WOW, my body switched gears and I could eat it all no problem!

      Vit C and zinc immediately jump to mind for slow cold recovery. I’m a fan of more fruit 🙂

  43. Thank you for the good wishes, Paul. I must say that I noticed scalloping along the edges of my tongue again this morning. Did a little checking—hypothyroidism? Lots of blood work with the allery doc, so we’ll see.

    Shared my heart valve news with a colleague and she told me, good-naturedly, that she has a bicuspid aortic valve and was told she won’t live past 70 (now 55). She was smiling big and asked why I don’t just accept the news and live what life I have. Hmmm…partly because if I were younger I would be into human physiology research, as I find it fascinating. But also, it seems there are so many things yet to do.

    Found Linus Pauling’s Therapy for Heart Disease and am wondering if it might help the calcification of my aortic valve. His protocol requires elimination of supplmental calcium. Life Extensions and cardiologist say that calcium supplements to prevent osteoporosis do not contribute to calcification of heart valves. Really? Here is the link to Pauling’s stuff: http://practicingmedicinewithoutalicense.com/#REVIEWS

    Follow the links to read the “excerpt” for his concise protocol.

    Years ago when I was pursuing my biology degree a prof told me that the thing about Linus Pauling is that no one has ever been able to prove him wrong. Can that still be said?

    Know you’re busy and appreciate your thoughts. Have a great salmon recipe. How do I share it?

  44. Hi Paul,

    I was hoping to get your opinion on my issues at the moment. I have some gut issues i’d like to get a hold of. Currently i’m practically on a GAPS/PRIMAL diet which has helped me in finding some natural relief from constipation which is what lead me to search for answers online and came across FIber Menace, Mark Sisson Primal Blueprint and alas Perfect Health Diet.

    I’m at a point where i’m lost, i think i am reading into too many things and should try relax a bit more and try just do what feels right. Problem is i’m not sure what that is for my problems. I feel like i have a disbyosis issue, which is why i was diagnosed with fructose malabsorption and colon inflammation. Also had mild gastritis, H.Pylori and gastroparesis. So the whole dame lot. I think it’s a testament to all the things i’ve applied to my diet and lifestyle that i am living pretty normally considering that list of conditions.

    Currently i am suffering from constant low body temperature, not optimal concentration and brain function, waking up during the night now and then, and my stools vary in shape and consistancy. I think, higher fat produces smellier and more sticky stools which require lot of toilet paper..not pleasent sorry for TMI.

    My persistant goal is to find the right balance in my diet. I notice you advocate safe starches which sounds great but i worry whether it will be detrimental to me and feed the bad bastard bacteria in me. I would avoid sweet potatoes due to FM and potatoes due to nightshade, thus i would love some rice again. Fruits i’m not very fond of, and i am never really sure whether low carb is best for me. So i’m in a dilemma, looking for help and some advice on a approach to take.

    Any tips/advice? Greatly appreciated.

  45. Paul and all readers,

    I have read that H. pylori is associated with a wide variety of health problems, but are you aware of cases where H. pylori seemed to be the primary cause of major systemic (as opposed to narrowly gastric) disease, which then resolved upon treatment of H. pylori?

    I ask because I finally raised the money for the Metametrix GI Effects stool profile and was “disappointed” to learn that the only irregularity was H. pylori. I expected to find other infections, given the severe metabolic/neurologic/hormonal problems I have been experiencing despite strict adherence to a healthy diet (albeit very-low-carb, forced by my unexplained dysglycemia) and being lean and strong.

    Most people that I have talked to think there is no way that H. pylori is behind these problems, and that it is not worth treating in the absence of something like an ulcer.

    Many thanks.

  46. you might want to back off on the “H. Pylori is the root of all evil” approach…turns out our commensal friend is probably at least marginally good for us…


    • I still haven’t seen any evidence that H pylori is commensal. Suppression of ghrelin is not surprising, it’s threatened by stomach acid so it’s natural it would suppress appetite when you eat, to try to make meals small.

      Genetically H pylori evolved pretty recently, ~70k years ago, so it’s not likely to be an “Old Friend.”

      I haven’t said H pylori is the root of all evil, but its disease associations are pretty solid.

  47. Hi Paul et al,

    Quick question re: bone broth. Have you seen this article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279073/?tool=pubmed&fb_source=message ?

    What is your opinion of it?

    I’ve been drinking beef bone broth for almost a year and I know it’s one of the WAPF healthy foods and the PHD adopts it to, along with GAPS ..etc.

    Is it likely to cause issues in the quantities mention in the article? A few litres it per week?


    • Hi Andrea,

      Great question. From what I’ve heard, bone broths can have around 1,500 mg calcium per liter. You want about 750 mg per day from all sources. A typical bowl of soup is 300 ml which translates to maybe 450 mg calcium. I think that’s about right; I can see a PHD diet without broth may typically have 300 to 400 mg calcium, unless you eat a lot of green leafy vegetables or dairy.

      He was drinking a liter a day, or about 3 bowls a day, so double the proper amount of calcium just from the soup, and it took 6 months to develop the hypercalcemia.

      He used “prolonged boiling”, whatever that means. Perhaps we should limit boiling to 3 hours, to hold down calcium levels.

      It might not hurt to get calcium levels tested when you have routine doctor’s visits too.

      Best, Paul

      • The Vietnamese people in my city seem to eat bone broth (Pho) constantly. I’ve asked, and they say that’s very common in their culture. Hard to believe it’s causing big problems for them, as they seem remarkably healthy, but I suppose it’s possible.

        My guess is that Ron Rosedale is correct that the real issue is whether the body’s hormonal regulatory mechanisms are intact and properly sending calcium (and everything else) to the right places.

        • Thanks Paul, I think will personally limit the amount of boiling since I think it skyrockets my own Calcium levels (constipation).

          Bill, do you happen to know how long the typical boiling time is for Pho? I love Vietnamese food and use it as my go-to eating out food so I’ve always been curious… even more so now.


          • I’ll try to ask how they make their bone broth at my own local Vietnamese favorites. I doubt they’ll tell me though!

  48. George Henderson

    Besides the need for vit K2 to regulate calcium into bone, I see the problem in these terms;
    supplying unusual levels of calcium in supps means its absorption is not vit D dependent; Ca levels can rise without vit D.
    This causes two problems; Ca is greatly in excess of Mg (and perhaps promotes its excretion);
    and, vit D activation is downregulated to prevent uptake of even higher Ca levels.
    So that long-term supplementation of high-dose calcium might cause a functional vitamin D deficiency; one would have enough calcium, so no rickets, but other functions of activated vit D might be affected, including immune function.

    • Hi George,

      But in this case the long term supplementation of high-dose calcium was accompanied by excess vitamin D, not deficiency.

      What am I missing?


      • George Henderson

        Any vit D3 has to be activated by hydroxylation to 1,25-dihydroxy vitamin D3; and this is triggered by low serum calcium. High serum calcium inhibits activation of vit D3. Unhydroxylated vit D3 has ho hormonal activity.
        Because the normal dietary range of Ca is lower than that attainable from supplements, (and even dairy products are a relatively recent food for adults) this problem does not exist in nature so we have not adapted to retain vit D activity in the face of this high doses.
        this is just a theory, but it’s consistent with the mechanisms of Calcium hoeostasis.
        Primarily calcium is regulated by the actions of 1,25-Dihydroxycholecalciferol, parathyroid hormone (PTH) and calcitonin and direct exchange with the bone matrix. Plasma calcium levels are regulated by hormonal and non-hormonal mechanisms. After ingestion of substantial amounts of calcium the short term control that prevents calcium spiking in the serum is absorption by the bone matrix. After about an hour, PTH will be released and not peak for about 8 hours.[14] The PTH is, over time, a very potent regulator of plasma calcium, and controls the conversion of vitamin D into its active form in the kidney. The parathyroid glands are located behind the thyroid, and produce parathyroid hormone in response to low calcium levels.

        The parafollicular cells of the thyroid produce calcitonin in response to high calcium levels, but its significance is much smaller than that of PTH.

        • George Henderson

          Because, if Ca concentrations in the gut are high enough, it can enter the blood by passive diffusion, without Vit D being activated.
          These levels would never be seen in nature, or if they were, would not be maintained every day for years.
          Once this high serum Ca is present, this decreases activation of vit D.
          If vit D was being activated in the kidney, the excess Ca could not be excreted.
          So you have high Ca levels that are no longer dependent on activated vit D.

  49. Interesting study on absorption of nutrients from vegetables depending on types and quantity of salad dressing: http://www.latimes.com/health/boostershots/la-hab-salad-dressing-20120620,0,362289.story

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