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. Anyone able to comment on whether resistant starch (say brown rice) as a carb source is better option for someone that may have small intestinal bacterial problems?

    As my post above, i fear i don’t want to feed bad bacteria by reintroducing some carbs, i am pretty low carb at the moment i’d say ~50gm and am feeling like crap. I want my life back it’s been a hectic last couple days really not enjoying a fulfilling life (i don’t ask for much other to just function normal as i can day to day, but i am seeking thoughtful advice on carb+gut bacteria links/research.

    Thank you

    • I think white rice is better than brown rice. I do think you should find a carb source that gives you minimal trouble so you can eat more carbs. Have you gotten diagnostic testing done?

      • Hi Paul,

        I did the lactose and fructose tests, came back positive for fructose malabsorption. They also found mild gastritis, H.Pylori and some inflammation in my colon, which was diagnosed as Ulcerative Colitis, although i’ve had another specialist question that and simply suggest that it was just some inflammmation but not as bad as UC.

        Judging by what i’ve read and my symptoms i would say SIBO sounds very plausible, as my only main concerns are on-and-off constipation and some bloating/gas issues. Otherwise i’d say i function pretty well, but the low carb has taken its toll.

        I will try as per your book and do about 3 days a week of 1cup of rice and see how i go, i will try not mix it with much fat or fibre to allow it to digest quicker and thus hopefully avoid bloating/gas.

        I think 100-120g of carbs would probably suit me, and i guess that is fairly low carb compared to most diets.

        I plan on geting your book to hopefully read more into SIBO and carbs.

  2. When increasing iodine, will even a tiny amount of wheat throw your body off for six months (due to auto antibodies)? I had one piece of fried green tomato with some kind of batter on it that had wheat in it, for example – must I now wait six months to gradually increase iodine? (currently at around 500mcg/day)


  3. Real Food Eater

    Hey Paul,

    I was reading your Zero Carb Dangers post and noticed that when you were zero-carb, you got 3 cavities. From what I understand, correct me if I am wrong, cavities are caused by an imbalanced calcium-phosphorous ratio in the body. When these vitamins are out of balance, the body takes them from the teeth, effectively leading to cavities. Therefore, when you were eating zero-carb, were you not eating foods high in both calcium and phosphorous? Or is there another element of zero-carb eating that promotes cavities?

    Tooth decay is a fascinating subject and I think it would be awesome and very informative if you did a post on it.


    Real Food Eater

    • Great question. Yes, it’s possible I could have been calcium deficient, though I did eat dairy and green leafy vegetables and take a multivitamin. I’m not sure what the cause of the cavities was.

  4. Hi Paul,

    I have been searching the web for some information about VLC diets, high blood sugar, and hypothyroidism (and I am not sure these are exclusively relate).

    Since going low carb in January and VLC over the past month, my weight has actually gone up (145 January, 153 now) and my blood sugar, previously in the mid-80s on FBS tests is now in the 110-127 range. I now test my BS every morning, per my doctor, to see if it stays in this upper range daily. It does.

    I have had a mild case of hypothyroidism and have taken synthroid/cytomel for the past five years. Tried armor but had an allergic reaction to it. No matter what med I take my basal temperature is anywhere from 95.2-97.2. Since going VLC my basal readings have actually increased a little bit…but so hasn’t my blood sugar!

    Despite these changes, my weight stubbornly clings. My initial goal was to shed 10 pounds. Now I am at 15 pounds to lose, but I don’t want it to go higher than that. I have read post after post about LC and VLC and how weight sheds…but mine increases! Without going into boring details, I really have followed “plans” and meet the carb/net carb/high fat/low protein criteria, etc… Any thoughts on how a body clings to weight despite eating fewer than 15 carbs per day, and less than 40 grams of protein? I have not eaten sugar, starches, nor gluten in six months. I eat dairy, via cream and full fat cheese, but that’s it. No alcohol, either.

    Should I also note that I am 48 and peri-menopausal? Also, I have been sick for the past 5 weeks and cannot shake this illness!!

    Any thoughts on what gives with this myriad of complaints? I can tell you my doctor is stumped, and she is a pretty inquisitive gal.

    Last, I have read your book (I will need to re-read about three times to understand it!) but am just searching for some answers to my specific questions before changing eating plans once again. I am, truly, starting to get a little nervous about the increasing FBS and would like to address that as much, or more, than my concerns about my weight.

    Thank you in advance,


    • Hi Amy,

      “eating fewer than 15 carbs per day, and less than 40 grams of protein” — there’s your problem. You’re starving yourself of vital nutrients.

      Weight loss is easiest when you eat close to your actual nutrient needs. Try 400-600 calories carbs and 400 calories protein a day.

      See here for more: http://perfecthealthdiet.com/2011/02/perfect-health-diet-weight-loss-version/.

      • Thanks for the reply. Just to note, I have only gone VLC for a few weeks, and completed a three day “fat” fast this week. I hated it and was no more “successful” than on any other of these ventures. Prior to this (for the past few months) I tried to aim for 70% fat, 5-10% carbs, and 15-20% protein.

        Last question: if I increase carbs as per the recommendations in your book, after ingesting so few of them for the past few months, is there the potential for anything like a “rebound” effect? In other words, will the carbs potentially trigger more of an insulin response than in a person who has not been eating VLC?

    • Hi Amy,

      are your blood sugar readings only from the morning? Try measuring before lunch or dinner to see what your levels are like during the day. You could have the “dawn phenomenon” which indicates that your liver is creating excessive glucose in the morning but your blood sugar management is ok during the day.

      Unfortunately I don’t know what to do if that’s what you have, the only treatments I found involve insulin shots, leaving people that are pre-diabetic out in the cold. (My mother has this problem)

      • Hi Wout,

        I take a daily FBG reading, but I have measured, intermittently, one and two hour post meal readings. They are usually lower, but still not very low. On occasion they have been higher (Ex: FBG a.m.=116, one hour post=117, two hour post 126). I have read about the dawn phenomena as well and have wondered if I have this. I have also read that one of my thyroid meds, cytomel, can increase blood sugars. I went without it for one week and nothing changed. I also have read that dairy can increase blood sugars…that is still out for the jury. Some days with more (in the form of heavy cream or heavy cheese) and some days with little (heavy cream in coffee). I have not taken it entirely without the cream in my coffee, which measures one T. per day.

        Thanks for chiming in. I appreciate it.

  5. Hey everyone,

    I have a question regarding herbs and spices that stimulate stomach acid secretion. I ask you because, well, internet can have pretty opposite views when talking about the same herb. I’m talking specifically about Ginger root and Black pepper corn. If you have any other more potent suggestions, they are greatly appreciated

    Thank you everyone

    • Hi Juan,

      why not take the guesswork out of it and supplement betaine HCl until you’re back in shape? Some other tips here:


      • Hey Wout,

        Thanks for the advise. The thing is I’ve already tried Betaine HCL. I get stomach pain with just 1 pill, but the bloating and flatulence certainly decrease. So maybe a weaker approach is in order until I can tolerate the Betaine HCL. I mentioned Black Pepper and Ginger because they are mentioned in the GAPS Diet, Why Stomach Acid is Good for You, even the link to Chris Kresser´s 3 steps for eliminating Heartburn, but I wanted to know if anyone had already tried the herb approach. Any ideas are more than welcome. Thanks again

    • The Weston A Price foundation had an article in their newsletter recommending bitter herbs for stomach acid production. I don’t recall the specific herbs, you might find it on Google.

  6. Can anyone tell me if pork rinds that you buy in the grocery store are okay to eat on the PHD?

  7. Julie, Read the PHD series on pork. Lots of better choices of things to eat! http://perfecthealthdiet.com/2012/02/the-trouble-with-pork-part-3-pathogens/

  8. Hi Paul
    In your book you suggest supplementing Vitamin K2 at a minimum of 100mcg or perhaps several mg. It is difficult to know what the appropriate therapeutic dose is! Weston Price seems to have been successful in treating cavities by using butter oil which probably would have contained less than 100mcg/day of K2 in MK-4 form. On the other hand, some recent trials have used 45mg/day of synthetic MK-4 which suggests that there could be a difference in the efficacy of natural compared with synthetic. Do you have thoughts on this? Did I read somewhere that Shou-Ching successfully treated a health condition with K2? If so, can you say what were the amounts.
    Many thanks

    • Hi Terry,

      100 mcg is probably sufficient to reduce uncarboxylated protein levels by 80%. So on the 80-20 rule that’s a great dose.

      More might be appropriate if there is an elevated risk of cancer or heart disease, ie someone who has atherosclerosis.

      Also, vitamin K lasts several days in the body so you can take larger doses weekly or twice weekly rather than a smaller dose daily.

      Shou-Ching had joint pain and stiffness that went away after K2 supplementation. She took a 1+ mg capsule once or twice a week.

  9. George Henderson

    I suspect that the 45mg K2, produced in Japan, is based on the levels found in natto, the use of which in Japan might have suggested such a high dose intially.
    I believe that in one study even 10mcg increments in K2 intake were associated with reduced CVD risks.

  10. I suspect I am suffering from some kind of bacterial/viral infection or fungal overgrowth and have been been for quite some time.

    Does anyone have a recommendation for an open-minded physician in Chicago that could be helpful to me, or any physician that conducts remote consultation?

  11. Hi Paul

    This is Koki here, a desperate mama of two lil boys, who is suffering from severe abdominal pain. One of my friends seeing my suffering said that I should talk to you about it and seek for help.

    Basically I am very disciplined when it comes to health and nutrition

    I dont eat sugar or processed food
    I only include white rice, potatoes, plantains and sweet potatoes for starch
    I eat chicken or fish once a week, but include plenty of vegggies fruits and egg
    Dairy was a good part of my diet as I am close to vegetarian than the paleo
    I take fish oil and probiotic supplements
     ( I dont exercise or work out, except for walking and playing with my boys… planning to include workout soon)

    This being the case  4 weeks back I got abdominal pain. Gyno docs checked and said no problems in uterus or ovaries no hernia .
    After a few days the pain got worse. Additionally i felt my bowel was not empty everytime I pooped and had to use the restroom couple of times but still i felt the bowel was not empty. I did not have pain or difficulty though.
    I went to general physician, he heard the symptoms and put me on antibiotics and prilosec for 14 days. AFter 5 days i called up to check the blood work results as there was no improvement in pain.
    They said I was h pylori negative, I asked them then why should I take antibiotics so they pulled me out of that and then sent me for ultrasound and CAT scans. They ruled out gall or kidney stones and pancreatitiis
    It showed fecal build up in colon though.
    Then they sent me to  a GI doc. He did endoscopy and they say grade 1 gastritis and esophagitis related to gastric reflux. They put me on PPI and Miralax. 
    I know the longterm use of these are so bad so I hate to take them. but as I have to take care of my kids, I have started taking them.
    It makes the pain bearable.
    But wihtout the laxative I  dont do well 🙁

    I want to handle this issue better without medicines. Is this intestinal dysbiosis ? How can I restore my gut health.
    Any help will be highly appreciated

    • Hi Koki,

      I don’t know what it is but I would try some experimentation:
      1) Remove foods that are common allergens, such as egg whites, dairy, nuts, etc. Google food allergens and compare to what you eat.
      2) If you’re supplementing, try stopping what you’re taking. If you’re not, try starting with a sensible choice of nutrients. See our recommended supplements page, maybe add a B-complex 2-3 days a week.

      You could also ask for a stool test, one we recommend is the Metametrix Microbial Ecology stool profile.

      For constipation, be sure to take magnesium and other supplements listed in our blog post on constipation.

      Let me know how things go.

      Best, Paul

    • Hi Koki,

      Probably too simple for all you’re going through, but just reminded me of when I get stomach pain eating too many raw veggies.

      Hope you’re feeling better soon,

  12. Hi,

    I hope you can give me some advice about anything extra I can do for my weight and health problems. I’ll try to keep it short.
    I’m female -31 – 5’2 – currently 189 lbs (highest weight: 235) I’ve lost all that weight recently with low carbing. Started out very low but have upped it to 50-53g of carbs a day. I eat about 80g of protein a day. I know that’s not enough to equal 600 carb/protien cals a day but when I go higher my weight loss seems to stall. I’m eating between 1550-1750 cals a day.
    My problem is really that I’ve got some health problems that are making my food selections a bit harder.
    1. I had my gallbladder removed in my early 20’s and since then I have chronic diarrhea. I have to take Welchol (bile acid binder) to stop it.(or at least slow it down). I still have to take Immodium AD about once a week. This obviously causes a problem with fat absorption (it runs right through me) but also makes it impossible for me to eat vegetables. If I eat even one serving of veggies a day I’ll be in the bathroom all the next day. I don’t know if it’s the fiber or what. Should I be worried about what I’m missing by not eating vegatables?
    2. I have disabling depression and anxiety. (Dysthimic Depression with periods of Major Depression. Social Anxiety disorder/general anxiety disorder/mild agoraphobia). This doesn’t change my eating it’s just a health problem.
    3. I have some blood sugar issues. Since eating low carb my fasting and post prandial reading are back to being normal but whenever I try to eat rice or potatoes (or any of your safe starches) my post-prandial readings go crazy. It has changed over time though – I used to have a kind of reactive hypoglycemic problem within a hour (glucose reading would drop to 40-60)so I gave up for a while and tried again about a month ago. I didn’t have a hypoglycemic reaction (which I was happy about) but after 2 hours my post prandial reading was not back to normal like it usually is – it was still climbing. It seemed to level out at about 3 hours but it took till my next meal before my reading was normal again. And it got up to the mid 150s so it also went a lot higher than normal.
    4. I have family history of CVD and diabetes. I am very concerned about avoiding these.
    5.Medications. As I’ve mentioned I take Welchol but I also take an anti-depressant (Luvox) and occasionally take a anti-anxiety pill (Tranxene). I also take Prevacid for GERD problems/ulcer. Since eating LC I’ve been able to cut the Prevacid down from 45mg daily to 15mg every other day. I am trying to ween myself off it completely. I also have dysmennorreah and mild endometriosis and I am taking BC pills for it (I have to take just the active pills and skip the placebos at the end – so I don’t have a period). The anti-depressants and BC pills make my weight loss pretty slow and I’m concerned about what these meds are doing to me long term.
    6. I’m pretty sure that I have some hypothyroid problems but I’ve never been to a doctor for it. My gyno thought I might have some problems so he tested my TSH and it was 3.9 (this was about 5 years ago). He thought this was ok (I did NOT think it was ok but I don’t know if I can deal with something else being wrong with me) I haven’t had it tested since and I’ve never had any further tests (like T4/T3/ rT3 etc.)

    I follow your recommendations about eating as closely as I can. (I don’t eat grains, veg oils, legumes or fructose (except for what’s in the fruit I eat and the small piece of dark chocolate I sometimes eat). I eat about 1.5 oz of Salmon a day. 2-3 oz of berries (plus another fruit like a peach or something lower carb). The meat I eat is beef, lamb or fish. I eat about a handful of nuts a day. And I eat cream, butter and cheese. I should have told you when I was talking about my blood sugar that I eat about 17 carbs at each meal (3xs a day). If I try to eat much more than that my glucose readings get too high. I follow all your supplement recommendations. too.
    If you have any suggestions please help.
    Thank you.
    If you have any suggestions about

  13. I apologize in advance – I’m sure this must have been discussed sometime previously. Regarding cheese, listening to the Loren Cordain video made me wonder if the naturally occurring milk hormones are still present in cheese and if consuming it’s potentially harmful. Any thoughts?

    Re: fermented foods – a gairtopf crock makes great fermented vegetables. Can take up to 6 weeks but makes several liters at a time….nice and sour and healthy.

  14. Hi Paul and Mark thanks a lot for your responses. Greatly appreciate it. Just now got back from the doc. my biopsy results came out. I do not have any infections or issues. No H pylori yayyy. The doc wants me to be on PPI for 3 months 🙁 and also on laxative once or twice a week. He just wants me to avoid spicy food and take probiotics. He says mine is silent gastrotis without heartburn. He said he will not want me to do a stool profile for he feels I dont need it. 🙁

    • Koki, I’m glad you don’t have any obvious serious problems, but that doesn’t mean you don’t have any. I think you’re placing too much confidence in what sounds like a very cursory exam by a very ordinary doc. PPI and laxative? This is not building health, this is typical, unhealing advice (in my addmittedly completely amateur opinion).
      I’d follow Paul’s suggestion and start with the stool test.

    • Koki just a thought. Do you think you may have sleep apnea? It can cause reflux (you pull up gastric fluids during sleep as you try to breathe with a blocked airway, then the esophageal sphincter weakens and it gets worse).
      If you suspect it, your insurance might cover an in- home sleep test.

      • george henderson

        how long have you been taking the probiotic? This sounds to me like it could be a response to a new strain, or high doses. Not all probiotics are ideal for everyone. I don’t tolerate L. Rueterii strains like Shirota well, prefer rhamnosus or bifidus.

        • Why suggest that probiotics, which shouldn’t cause constipation or reflux, are the culprit?

          • george henderson

            Doesn’t look like this posted, so I’ll try again:

            One of the most common side effects associated with taking probiotics is constipation, since they can halt diarrhea as they work to restore balance. However, constipation might signal more significant problems. Taking probiotics—especially when too much is consumed by eating yogurt and taking a supplement, for example—can bring on a side effect known as excessive drainage syndrome. The symptoms of this syndrome include constipation, headache and bloating.

            True story.

  15. Hello Paul

    I am a 6th year medical undergraduate from Australia. I want to start by quickly mentioning how interested and thankful I am for your work, I spent my entire off reading your blod posts and cited studies, I had to force myself to go to sleep I was so curious.
    I’ll try to get to the point, I don’t want to give you an essay to read.

    My mood and bodyfat levels are best when on a ketogenic diet. The issue is, I often get repeated tongue ulcers. I call them ulcers, but they are strange. They normally are invisible on my tongue, but they tingle in a semi-painful / annoying manner when I rub my teeth over my tongue or eat food, particularly acidic foods. They are sometimes visible as tiny white dots, and if they are really bad and I rub my teeth over them (even gently), they appear as multiple tiny spots of blood.
    Initially, on the occasional night out when I would consume alcohol whilst very low carb (<50g) or keto (<10g), the next morning I would wake up with these tongue ulcers. Also, if I consume a large amount of pepsi max, I get them. The other day, I had been doing neither of these things and I still woke up with a bunch of them – the preceding three days my tongue had been feeling strange, almost 'dry' or perhaps powdery, im not sure how to explain it. Beyond this, I often get upper respiratory tract infections – frustrating mildly productive cough, when on keto.

    My question is this: Do you think this could be due to a mucus deficiency? Perhaps I'm allowing colonisation of some fungus fueled by my deep ketosis? I don't seem to have smelly breath when I have these ulcers. Is there any way to prevent this without increasing my carbohydrates as I do so much better when I am strictly keto, with the occasional carbohydrate load once a week or so. Any ideas would be very much appreciated!

    Maybe relevant info: I have mildly low platelets (between 110-140, reference 150-450 in Australia) and occasionally mildly decreased white cells (not too often). Haematologist did lots of blood tests and couldn't find anything, just gets me to check 6 months and says its just normal for me. Discovered this four years ago and hasn't changed, doesn't seem to be a problem.

    • Hi Thomas,

      That’s a puzzle. I don’t know what it is. You could try getting a doctor to scrape one and culture it to see if it is fungal, but that is not entirely reliable.

      Have you tried antibiotics? I doubt the tongue ulcers are bacterial but there could be a bacterial brain infection that may be why you do better on ketosis. If that were cleared then adding carbs might clear the tongue ulcers.

      The other thing to check is whether intermittent ketosis is good enough for the brain symptoms. If you eat carbs, but in a restricted feeding window, and take lots of MCT oil in the fasting window, then you might get the benefits of ketosis for the brain in the fasting window and the benefits of carbs for immunity in the feeding window.

      Just ideas. I really don’t know what’s going on.

    • Hi Thomas,

      I am sure that you have read everything there is on tongue disorders but in addition to the perfect health diet, I read an ebook, treating and beating geographic tongue and other tongue problems. I have not really read it carefully, only skimmed it but it may have some helpful points. Sounds like you have done your homework, but somewhere you will find the answer, keep trying!

      • george henderson

        Riboflavin deficiency can produce ulcers; this is consistent with the alcohol as a factor. Riboflavin is destroyed by cooking and is a relatively easy vitamin to become marginally deficient in.

    • Hi Tom-
      Sounds like canker sores.Check your toothpaste,because sodium laurel sulfate can cause the sores.Also,if you consume too many acidic foods in a short window,it can happen.eat some alkalizing fruit,take some glutamine and some creatine.Also,a quick and dirty way to alkalize is to take alkaseltzer gold…Once they appear,they will stay awhile,but you can shorten the duration…and avoid highly acidic foods,and the wrong toothpaste.

  16. Does anyone have experience/thoughts about cranial electrical stimulation? My physician has prescribed a unit from http://www.fisherwallace.com/

    I have chronic pain after being butchered by a hernia surgeon, and associated depression. I, of course, don’t intend this to supplant addressing infections/PHDing/general healthy living, but am considering it as adjunct therapy.

  17. Hi, My aunt has been on a Ketogenic diet ala PHD – with supplements and IF for 1.5 years to successfully control dizzy/equilibrium problems. Recently, due to compounded spinal problems she tried including excess kale/veggies to use Dr. Terry Wahl’s ideas to help with spinal nerve healing, but her neuro symptoms come back (out of ketosis?).
    My questions: 1. what is the next step to cure the neuro issue – antibx trial? (neurologist only answer is epileptic-like activity – all other scans negative) She does use doxy periodically for rosacea…should she try for extended time to check for relief of neuro Sx?
    2. Do you think autophagy/nutrients can help a damaged spine – stenosis, ruptured discs, bone spurs?
    Thank you as always, for you time, genious, graciousness, and integrity. –Kriss

    • Her spinal problems sound like she needs vitamins A/D/K2/C, maybe some joint broths (ox hooves/tail, chicken foot – a lot of joint tissue cooked into a soup).

      Antibiotics might help, I don’t know.

  18. oops..’genius’

  19. :?:have autoimmune and cfs with gut dysbiosis. Nutritionist put me on diet which is gaps and paleo like with no sugars from vegs or fruit, no honey. Hair very very dry, hair lose also, eyes dry etc. Would iit be better for dysbiosis to add fruit and honey as in gaps or go with safe starches. Slightly improved on diet but have added new symptoms so over all not that much better in seven months, plus underweight. 5’5″ 106lbs. Normally before this relapse 115 to 120lbs. Am always hungry!

    • You do need carbs, Renee. Which ones are best depends on what kind of gut infection you have. Usually dextrose or rice syrup work best. Fruit and honey are OK on colonic infections. Rice is good for SIBO. Experiment to see what works for you.

  20. Steve Reichard


    I was wondering if you have an opinion on saccharin.

    To me, it seems like the safest of the artificial sweeteners – it’s been studied something like 3,000 times and never found to be harmful to humans.

    The only downside I can think of is that its sweetness might raise insulin, as the body prepares to handle the sugar that normally follows the taste of sweetness. Since the sugar never comes, the insulin would lower blood sugar, perhaps leading to hunger.

  21. Thanks Paul,
    Gastric doc did say I had celiac and possibly SIBO. Alternative doc with his nutriionist focusing on candida and dysbiosis with diet and rice protein shake with 30 grams of fructose. I refused to do shake with fructose and slip in butternut squash as restricting food sugars vs fructose seemed foolish. However, I think their diet dependeD on carbs from the shake which I didn’t do. Reading your book had me really questioning their advice. So with gut dybyosis, candida and SIBO what is the way to go with safe carbs? Sorry I wasn’t as clear at first. Tried to keep it short!

  22. Paul
    This is koki again. I had been to the gastro doc and he is not for the stool test. I am not sure how to go about it . Can i get it done independently? Will insurance cover it?do you think a food allergy test will help?
    I dont take the laxative for past 3 days instead i supplement magnesium transdermally and eat a lot of veggies and fruit. Today i felt like my bowel movements were far better.
    I eat white rice or fermented rice batter pancakes once a day. Can this rice cause constipation?
    I never had heartburn or reflux just abdominal pain. Doc says i cud have eaten something that caused damage to stomach n esophagus lining. Could it be dark chocolate as a couple of months back i was addicted to it.

    I dont think i have sleep apnea as far as i know. I had a c section a year back wondering if a pregnancy a year back had anything to do with this issue at all

  23. Again, I’m just a layman at this, but I think the fact that you’re trying to figure out the cause of the GERD is going in the right direction, rather than the mistaken alternative of trying to shut off your (very necessary for health) stomach acid in anything more than a temporary way.
    It’s not illogical that the pregnancy may have affected the esophageal sphincter in some way, so that’s not a bad guess. Think about what kind of physical shape you’re in and whether it could be bunching up your internal organs. The upper stomach can actually creep up through the esophgeal sphincter, and believe it or not you can sometimes get it back down by drinking some water and hopping up and down till the filled bag of your stomach pulls it back into place.
    Yes, you may not have OSA, but don’t discount it just because you haven’t noticed anything in particular regarding sleep. OSA is very sneaky; it takes place when you’re unconscious after all. It’s very, very common, and most people who have it don’t have any idea that they do. I’m not trying to convince you that you suffer from it, just to have you consider it as a real possibility to check out. Here’s a link
    Good luck.

    • Forgot to mention:
      Visceral fat, the fat surrounding your internal organs, can push things out of place, squish the digestive tract and impede its function. The closer you can be to your ideal body condition through eating the PHD (which it sounds like you’re doing) the less likely that you’ll be subject to metabolic syndrome and the attendant buildup of excess visceral fat.

  24. In the book, you briefly touched upon Quinoa and a few other ancient grains as possibly being ok to eat…..what about gluten-free spelt?

  25. Hi I just realized that here in Hong Kong I have an abundant supply of what could be the ‘perfect’ PHD meal.
    I was looking for a way to use fish broth and ingredients I had on hand. Internet searching found a fun site which talked about a rice porridge/soup dish called congee. I thought that sounded like a pretty good way to use the fish broth and combined some of the congee ideas to come up with a very yummy side dish which easily could have been our main dish.

    Congee is supposed to be a kind of rice soup. Congee is amazingly frugal with the most basic congee being rice and water. I upped the nutrition value a bit using bone broth and a few veggies. Even with those changes is was still incredibly inexpensive.
    Congee Basics
    1 cup white or brown rice rinsed until the water runs clear (the idea is to remove most of the starch)
    6-12 cups of water or bone broth (depending on how thick you want your congee to be)
    Combine the rice and water in a rice cooker (do not fill your rice cooker more than 70% to allow room for cooking). If you do not have a rice cooker you can cook it on the stove top. But for ease of preparation I loved using the rice cooker. Look here for other cooking methods.
    Add three thinly sliced carrots

    Put the cover on the cooker and turn it on. I went back and stirred it every 10 minutes or so to help break down the rice. In this picture I used 1 1/4 cup white rice (I try to make food familiar when I’m trying new things and my family loves white rice. Next time I’ll use brown), 7 cups fish stock and the carrots.
    While the rice was cooking I cooked some kale and mushrooms in coconut oil.
    I stirred in the kale/mushroom mixture and 2 teaspoons of coconut oil.

    The finished dish. Rich with healthy bone broth, carrots, kale and coconut oil. The options for making this ‘Congee’ are endless and I look forward to making this again.

  26. Hello. My dad was recently diagnosed with the bone marrow disorder MDS, Myelodysplastic Syndrome. The primary effect right now is a really low platelet count (under 10,000 at times). Does any one have any specific supplement recommendations. It’s unlikely I will ever get him on PHD. I am trying to at least get him to take supplements but even that is difficult because the Dr. implied they won’t help. I read the following can be beneficial for platelet counts: Folate, copper, zinc, selenium, K2. Any thoughts out there would be appreciated. Any concerns about taking those while on/off chemo? The Dr. said his immune system is really strong which is good except that the platelets get wiped out more quickly after transfusions.
    Thank you for your time!

    • Hello. I wanted to repost to see if anyone has suggestions for supplements to increase one’s platelet counts. This is what I found: Folate, copper, zinc, selenium, K2. Any additional thoughts are appreciated.
      Thank you.

  27. Real Food Eater

    Hey Paul,

    I noticed you have not posted an article in a while. Is this because of the cookbook and Perfect Health Diet book? When will you be back blogging?


    Real Food Eater

  28. I read here in qa section that probiotics can cause constipation. How do i find which strain is causing that issue? I started taking it regularly after the docs put ne on antibiotics suspecting h pylori. I also give my sons probiotics as it helps them avoid ear infections and other allergies. Will that be a problem too

    • Probiotics causing constipation? And your GERD? Why would they?

    • Whoops, I missed George’s post on the constipation from probiotics. Now I see how it can occur. But, since
      1. That’s the uncommon, not the common, result from probiotics. And they are usually a help, not a hindrance.
      2. We don’t know if Koki is taking the excessive amounts that may (or may not)cause the uncommon reaction.
      3. They shouldn’t cause GERD, which she says has been found in her exam.
      Why then suggest it as the probable cause of her problems? Now she’s ready to quit giving her sons probiotics.

      • George Henderson

        I agree about the GERD; if it’s acidic,
        that’s not something I’d associate with probiotics. Mucus, maybe.
        The constipating effect happens early on and can go away. But not all strains are like this.
        I think it is fairly easy to tell if the probiotics are the cause just by stopping and starting them. It is a recent change and a possible cause.
        I wouldn’t avoid probiotics because of the possibility, there are worse things than a little irregularity, but something that worries you is worth troubleshooting thoroughly.
        FWIW I think if the probiotics cause it it will go away if you keep taking them, and it is unlikely that they would affect another person in the same way.
        But stopping and starting is the best way to check.

  29. I know you probably haven’t had a chance to look over this study yet but worth discussing at some point? http://www.latimes.com/health/la-sci-calories-20120627,0,3966421.story

    Seems to point out that a VLC diet isn’t idea overall, despite its benefits from a weight-loss perspective. The low glycemic diet, which the study seems to recommend, has a higher carb load than PhD but perhaps PhD is in the sweet spot between a low glycemic and a VLC diet.

    • Hi LB, Paul’s book and various comments on this blog mention that VLC (10% in the article) are not good long term for various reasons. The VLC diet issue your article refers too, “risky for the heart”, also probably has more to do with the high corresponding percentage of protein not just low carbs by themselves. Here is a different study that mentions CVD issues with low carb/high protein intake: http://www.bmj.com/content/344/bmj.e4026. Your article also mentions concerns about lower fiber intake with VLC but PHD does not include plants in the carb count which have a lot of fiber.

      • George Henderson

        I think the “risky for the heart” claim is just the usual saturated fat bashing, with no foundation in fact. It’s unlikely to be something they tested, and it was disproved in the A thru Z study.

  30. George Henderson

    And 21 people?
    The VLC diet was actually the most efffective;
    4 weeks is probably not long enough to see the health benefits from VLC seen in longer comparative studies;
    and Ludwig has “always recommended” the diet he ended up preferring, even though it was out-performed by the VLC; so he wasn’t the objective scientist to begin with.
    One could certainly interpret this research differently. I’ll try to find the full-text version.

  31. George Henderson

    here’s the abstract.

    “The research subjects burned 350 calories more on the low-carb diet than on the low-fat one,” Ludwig said. “That’s roughly equal to an hour of moderate physical activity.”

    “The difference between the low-glycemic diet and the low-fat diet was about 150 calories a day, favoring the low-glycemic diet,” he added. “That’s about an hour of light physical activity a day.”

    Ludwig said the low-fat diet had the worst effects on metabolic syndrome, a group of heart disease risk factors. Low-fat diets had adverse effects on insulin sensitivity, triglyceride levels and good cholesterol levels, he said.

    The low-carb diet had drawbacks, too, he said, causing high stress hormones and inflammation that could increase the risk of heart disease.

    “I think what’s been lost in the last 50 years of dieting is an understanding of food quality. We’ve been too simplistic with the idea of eliminating all fats or eliminating all carbohydrates,” Ludwig said. “We should focus on the quality of foods and not try to eliminate a whole class of nutrients. The quality of the calories going in can affect the number of calories being burned off.”

  32. George Henderson

    This is the best news report on the study; from The Hindu of all places.
    Ludwigs low-GI diet was 40% carb, 40% fat, 20% protein; his “Atkins” was 80% fat, 10% carb, 30% protein. And only 11g fibre.
    The best part of the study is the measuring of metabolic rates; this is a “metabolic ward” study, and Ludwig wasn’t bamboozled by naive assumptions about thermodynamics.
    He should test the PDH next…

  33. been doing PHD for one month and just had my results back vs one month ago:

    Cholesterol WAS 5.51 NOW 5.1 Should be less than 5.2
    Triglyceride WAS 1.08 NOW 0.6 Should be less than 1.7
    HDL WAS 1.08 NOW 1.3 (Good cholesterol) Should be above 0.9
    LDL WAS 3.78 NOW 3.5 (Bad cholesterol) Should be less than 3.4
    Thyroid Hormones 13.52 should be 11.50-22.70
    Blood group O Positive

    Will keep this up – all i did was add good carbs and increase carb rations as Paul pressribes loweing protein to 15% and increasing fat to 65% – previously i was 100% primal blueprint low carb zero starch…thanks guys ! 🙂

  34. Molly Ryan-Fisher

    Could you clear up which oils are good and why they are or are not good? Art said canola oil is okay but I could not find your reasons for disagreeing. You mention sesame oil in some recipes, but what about the fact that they come from seeds (phytic acid concern)? And olive oil – I’ve read at high cooking temps (not sure what degree exactly) it breaks down causing an increase in omega 6s that makes it unhealthy. Thanks – looking forward to the next book!

    • Canola oil is 30% PUFA and we try to keep PUFA under 5% of calories.

      Best oils & fats:
      Coconut oil/milk
      Beef tallow
      Duck fat
      Olive oil, avocado oil

      You shouldn’t cook at temperatures high enough to break down olive oil.

  35. Hi Paul,
    Wanted to ask you what is your take on psyllium husks as a source of fibre?

  36. David Andrews

    Paul, I can’t remember if you had any comments about miso. It’s made from grain, but it’s fermented, so….

  37. With regard to magnesium, I used to get mine with my cal-mag supplements (tricalcium citrate and magnesium oxide), but as I rethink that in light of my aortic valve issues, I’m reading about magnesium chloride (magnesium “oil”) sprays. Prices on Amazon range from about $6 for 8 oz to $24 for the same amount. Wellness Mama suggests three different ways to up mag levels: http://wellnessmama.com/3610/are-you-low-on-magnesium/

    Right now I’m kind of adrift, afraid of the 1500/750 mg of my old cal/mag caps, I’m taking only a couple caps of mag a day, along with 300/150 mg of my old cal/mag caps.

    Of course, the Ancient Minerals folks claim that transdermal is the only effective way to supplement and that magnesium cloride is the only effective form.


  38. We are surprised by your favoring white over brown rice. My husband is diabetic and controls it w/diet and exercise only. He has avoided white rice since discovering it spiked his blood sugar. Brown rice does not do that. Is all brown rice toxic?

    • Hi Rose, Try mixing the white rice with vinegar, butter, and vegetables. See our post on how to minimize hyperglycemic toxicity. Also, some types, like Basmati, have much lower glycemic index.

      Yes, brown rice has a low-level of toxins. It’s an acceptable food but for most people white rice is better. If your husband consistently has a better response to brown rice then it’s OK to eat that.

  39. I am sure this question has a long response, but
    how do you kill off candida and how long does it take??

    • Good diet … sufficient carbs (600-800 calories per day) and protein … lots of vegetables: green leafy vegetables, olive oil, onions, garlic … berries/cranberries … root vegetables.

      Similar to an anti-cancer diet, actually.

      Treatments can help. Fluconazole and lufenuron both worked in my case.

      It usually takes months I think.

      • What do you think of ‘Sunun Weed”s advice? I know you think you shouldn’t have kefir because of the yeast (and some vinegars maybe?) I found it referenced from wildfermentation.com

        “You need to eat lots of moldy, yeasty, bacteria rich foods like yogurt and sour dough bread and homemade wines and unwashed fruit (for the molds on the skins) and miso and sauerkraut.”


  40. Dear Paul,

    Could you give some clues as to what might cause the following symptoms? My girlfriend has constipation, restlessness, anxiety, sleeplessness, no appetite, slight nausea and dizziness, general weakness and these symptoms have reappeared from time to time since her teens. At the moment she has a feeling of sickness that comes in spasms/waves. She is underweight and always had trounle gaining weight, had issues with constipation since her childhood. In the past she took a few SSRI medication but she gradually abandoned it. I would really appreciate a few words in response. This is so debilitating for her…

    • Hi kapos,

      I don’t know. Doctors would have a better chance to make a diagnosis.

      I do have a better idea of some therapies that will help:

      1. Circadian rhythm therapies. Light outdoor activity and sun exposure in early morning and at mid-day; no blue light exposure at night; sleep in a totally darkened room; eat within an 8 hour window ending at sunset.

      2. Address hypothyroidism and try the constipation remedies in our constipation post.

      3. Eat our diet (see food plate).

      4. Tend to gut flora with fermented foods.

      If it persists after these steps I’d try to get evaluated for chronic infections.

      • Thanks for your time Paul,
        We’ve been on PHD since about this January and it sure benefits me a lot, but my partner still has her problems, it’s interesting that you mention circadian rhythm since this time her instability started after her third day on night-shift work, she lost appetite and that (may have) kicked in a loop of anxiety, reigniting older (neuro)associations, I think, it’s hard to see her fall apart like that… Thank you again Paul, it’s sites like yours that make a difference

  41. I need help. I have been your diet for the last 3 weeks and I am still experiencing extreme fatigue daily.
    My day looks like this. Bkfst – is a bunch of greens and a protein and some fat in the form of coconut oil, flax or chia seeds. Pretty much all three meals are like this and then snack is some kind of nuts.

    What do I need to change? I cannot keep feeling like this. Help. 😐

    • Hi Sandra – That doesn’t sound like our diet. Forget breakfast for the moment.

      Dinner – either beef/lamb or seafood/shellfish; a safe starch (white rice, potato, sweet potato, taro); an in-ground plant (beets, carrots); a tomato and spinach or seaweed soup in bone broth; flavor the starch with butter/sour cream and vinegar.

      Lunch – leftovers from the previous night’s dinner plus 3 egg yolks.

      Breakfast – either skip this or have something like eggs and potatoes, eggs and plantains and tomatoes, puffed rice cereal with milk, cream of rice with cream and berries, yogurt and berries, banana and boiled eggs.

      Have you looked at our food plate?

  42. I asked this a few days ago, but it looks like it got lost in the slew of comments. What about spelt flour and breads made with spelt (no gluten added)?

    • Hi Kate,

      spelt is just an old variety of wheat. I’ve seen anecdotes that people with wheat sensitivities can handle spelt.

      Some grains cause lots of problems like wheat, and with others it’s not so clear, like oats or (not a grain) buckwheat. In general grains and beans have biochemical means of protecting themselves and until the science is there to disprove it, treat any grain or bean as suspect.

      I don’t know of any breads that provably don’t have any problem. Gluten free breads just replace wheat with other grains or beans and therefore can bring about their own problems. I simply do without bread and will eat the occasional (once a month or so) baked good if someone made it themselves.

    • Hi Kate, Spelt is a kind of wheat so it’s forbidden on our diet. It has less gluten than regular wheat so it’s not quite as bad, probably, but it does have some gluten and it has all of the other toxins in wheat plus some others it picked up from goat grass. I wouldn’t consider it safe.

    • Lauren,
      Years ago, I tried spelt when I eliminated wheat and the two month honeymoon was wonderful. A local bakery made the bread and it was the best ever. Then, without warning, the romance was over. That stuff suddenly gave me the most violent diarrhea. Wheat had never done that to me; gave me painful joints, but no noticeable digestive upsets. I have recently heard that spelt has more gluten than any other grain. I vote with Wout and, of course, the Jaminet’s, and stay clear of all cereal grains. In fact, I’m beginning to wonder if I will ever use my toaster again; certainly not until I come up with an acceptable bread recipe. Haven’t used it since discovering, two years ago, that my rice bread contained safflower oil, and those oils, for me, are as troublesome (or more so) as grains.

      • Whoops — I meant “Kate.” I’m sorry for careless reading this morning.

      • Whoops — meant to address that to Kate. Pardon my sleepy reading this morning. I sent this a few minutes ago, but it seems to have jettisoned someplace.

  43. I need some help! I may be having some yeast problems. I have had a coating on my tongue for some time and it does not get better. I thought it was geographic tongue but now I am thinking there is more to it than that. My husband said it looks like yeast. I also have some weird white looking stuff on my throat (not coated a bit of streaks). If its in my throat too it must be in my body…anyhow, I’d like to know what can be done about yeast if it is indeed yeast. Nystatin is a medicine but I am guessing more natural ways to heal it are better. I am following the diet so I am heading in the right direction!

    • Hi Lauren, You may need more carbs. Fungi do well on ketogenic diets. Carbs support immune function.

      There are also leukoplakias from nutrient deficiencies. You might try a B-50 complex once a week and be sure to optimize A/D/K and eat egg yolks, liver, and such.

      • george henderson

        Paul, have you ever eaten persimmons?
        The interesting thing about this fruit is, that they ripen and practically fall apart without fermenting in the least. They are edible when mushy without the slightest taste of alcohol or other fermentation products. Which makes me think there is something in them highly inimicable to yeasts…
        On the other hand, it’s a sweet fruit, and can be made into wine.
        I notice that persimmon leaf is in an anticandida tea touted online.
        Just an interesting observation at this stage, NOT a recommendation!

  44. Hi Paul,
    I have been suffering with a number of ailments over the last 7 years and doctors seem unable to assist. I have started investigating many things to try and see if i can help myself. During one of these searches I found your site and bought your book. I just want to know how do you do the exact calculations ? you mention a ratio of 20, 65, 15 but surely things overlap. If i have a piece of beef (which contains fat) how do I know how much is protien and how much is fat ?

    • Meat – if it tastes moist, it has the right proportions (2/3 fat, 1/3 protein). If it tastes dry, it is mostly protein and should be paired with something fatty (eg chicken breast with avocado, squid with an olive oil drizzle).

      Go by taste. Generally the tastiest proportions are optimal.

  45. Hello,
    I have a quick question regarding Candida and low carb diets. I have done some researching on Candida diets and many do not recommend the use of safe starches from the sugar standpoint. I was wondering why you recommend consuming the amount of safe starch calories that you do for fungal infections? Thank you very much for the book and for answering our questions.

  46. I have yet to buy the book, but I have been scouring the vast information on the website for the past few days. I am most interested in a regime to follow for fungal infections. I have tinea versicolor which could be caused by candida. Could you direct me to any candida posts that you’ve made that outline specific steps to take to eliminate it from the body. I know to eat a certain amount of carbs, but I am confused about yeasts. Should I avoid vinegar as this generally contains yeast? What about fructose as countless websites say not to eat fruit if you have candida. Also, what is the difference between yeast fermented and bacteria fermented products? I like yogurt, cheese and other fermented veggies. How do I avoid getting ones that are yeast fermented? Will yeast be listed in the ingredients?

    This may be a dumb question but what makes rice syrup different than other sweeteners like honey? Should it be used sparingly? Do you recommend the use of honey or maple syrup sparingly? Why are less refined versions of cane sugar like turbinado sugar not recommended? Is there makeup different?

    I’ve read so much about nutrition and your information is the best I’ve read in a long time. Everything kind of adds up to your diet and as I get hypoglycemia I rejoice in the addition of safe starches and your explanations of blood glucose levels and the glycemic index. For a long time I felt that moderate carb made up of vegetables/fruit and some tubers would keep me from having blood sugar spikes and drops, but I’m not so sure about that anymore.

    I am lean but I have tend to gain around my abdominal area and I would surmise that this is due to a diet of refined products and an influx of omega 6 fatty acids. What do you feel is the best way to combat abdominal or subcutaneous fat? Everything I’ve read on paleo sites recommends keeping the carbs lower to encourage fat mobilization and burning. Can we lose fat in the presence of insulin? What kind of body do you think that this diet will promote?

    • Hi Kelly,

      Pure vinegar is beneficial, but when you have an established fungal infection you do want to avoid consuming live yeast (or even dead yeast) as this can promote a fungemia.

      Yogurt is fine, so are many cheeses, but I would avoid moldy cheeses.

      Against fungi in the gut, most vegetables are helpful, especial salad ingredients: spinach, onions, garlic, olive oil. Against Candida in the body, immune support is important: healthy nourishing diet, avoid ketosis for more than a few hours a day, and give yourself circadian rhythm support with daily sun exposure and exercise, night time darkness.

      Rice syrup is made of glucose, it has no fructose.

      Cane sugar is composed of sucrose which is half sugar. Unrefined just means it has water and cellulose with it.

      Yes, you can lose fat when eating carbs. The key is minimizing omega-6, fructose, other toxins, getting good circadian rhythm support, and good vascular nourishment (D/A/K2, C, minerals, etc).

      Best, Paul

  47. Paul: Can you use Great Lakes gelatin instead of bones for beneficial broth? Any special way to use it?

  48. Catherine Joy

    Hi, just discovered your page because i need help with my flora! I was prescribed ciprofloxacin, which I took for 7 days. I then went back to the doctor because I was still suffering from diarrhea, going on for about 8 weeks, who prescribed Florastor. I have been taking that for 2 weeks but i don’t see much improvement.
    I printed off your diet which is very interesting but I am gluten sensitive and can only drink soy milk. Any suggestions please. I would be very grateful.
    Best regards, Cathy Joy.

  49. Thank you so much for answering my previous questions. I have been comparing your ideas with Ray Peat’s and there is a lot of overlap, but there is some great divergence in ideas. There were a couple of posts on Danny Roddy’s blogs, including the comments that I would love to hear your response to.

    1. http://www.dannyroddy.com/main/2012/2/13/why-thyroid-is-so-important-a-response-to-dr-paul-jaminet.html

    Someone states that “even Paul agrees that sucrose increases thyroid output, and is essential for T3, the case is closed. T3 causes all the reactions in the body that would decrease a need for adrenalin, and I think that even if sucrose had an immediate effect on the sympathetic nervous system, the thyroid support would far outweigh the negative effects.”

    Also a commenter brought up a couple of studies that negate what you wrote about in your post on sucrose and its effect on adrenaline.

    “Plasma epinephrine concentrations 25 and 50 min after sucrose ingestion were significantly lower than in WE [=Water Experiment] (P < 0.05)."


    Transient effect of stress hormone changes following sucrose: "Cortisol levels tended to be elevated in subjects fed the sucrose diet (P < 0.25). The apparent decline in weekly levels at Weeks 5 and 6 might indicate that the ele-
    vation of cortisol in subjects fed sucrose is transient." http://ebm.rsmjournals.com/content/169/1/36.abstract

    Also there is the discussion of fructose malabsorption:

    "The first is that pure fructose is malabsorbed while sucrose is not. I've heard peat advocate pure fructose in an interview so I don't think he's aware of this point either. Malabsorbed fructose feeds pathogens and subsequently terrible damage is done. Fatty liver is typical of fructose-fed mice, but the fatty liver is prevented if the mice are given antibiotics http://www.ncbi.nlm.nih.gov/pubmed/18395289 . Most all the anti-sugar studies are done with fructose rather than sucrose. There is some evidence that HFCS is also malabsorbed at a greater rate than pure sucrose, It should be noted that common soft drinks have higher fructose contents than reported on the label, to the extent that Soda/soft drinks may have fructose that is being malabsorbed, especially when paired with other digestive-enzyme blocking foods.

    The second is that fructose/sucrose likely requires certain nutrients for proper utilization, without which, damage is done. Choline is a good candidate, and possibly zinc. Inadequate choline consumption is common. Most anti-sugar studies are also preformed on mice eating purified, very deficient diets. Mice eating nutritious wholesome diets have consumed extreme amounts of sugar without harm."

    2. The biggest confusion I have stems from the different ideas that you and Peat have in what causes disease:

    One commenter did say that: Peat is a the lack of oxidative cellular energy stimulated by stress (estrogen, serotonin, endotoxin, etc.), Paul believes that most diseases are caused by the interaction of a bad diet with infectious pathogens.
    The two concepts are linked. A stressed body is exploited by microbes, and microbes are a chronic stress on the body. A nutritious diet fuels effective immune responses and protects the gut.
    I think Peat has talked about how most serotonin comes from the gut (where all the microbes live), and part of serotonin's function is to stimulate peristalsis, peristalsis probably being an anti-microbe function similar to diarrhea."

    I'm really interested to hear what you think Ray Peat's ideas of lack of cellular energy caused by serotonin, estrogen and cortisol and their relationship and any possible negative effects, plus what we can do to minimize these effects.

    Danny posts about serotonin here:

    estrogen here: http://www.dannyroddy.com/main/2012/5/14/estrogen-the-shit-show-hormone.html

    What about free fatty acids? I am mostly interested in stress responses because I have had panic disorder for my entire life and I am also waking up in the middle of the night shaking (not a hypoglycemic response). I feel that this must have something to do with cortisol, estrogen and serotonin. Two things that help with my panic are inositol and albizzia julibrissin (asian herb for depression/grief). These both act on serotonin receptors or help to create serotonin. Ray Peat seems to think that increasing serotonin as in SSRIs and St. John's wort is hazardous and he talks about it here: http://raypeat.com/articles/articles/serotonin-depression-aggression.shtml

    What would you suggest to help mitigate the stress response through diet and or supplements/herbs, and help to control estrogen, cortisol and increase or decrease serotonin. You did mention that these are complicated hormonal processes but I am the most confused about them and they seem to be very important!

    • Hi Kelly,

      I addressed the Peat-Roddy ideas in a few blog posts:



      I don’t have much more to say. There’s basically no science supporting the Peat-Roddy positions where they disagree with us. Of course, there is a fair amount of common ground.

      • Yes you did address eating sugar, and I agree with your take on that from reading your posts. But I am interested to know if you have anything to say about serotonin, cortisol and estrogen and the harm they can do to the body in excess amounts. Even Mark sisson talks about cortisol but Ray feels that estrogen and serotonin in particular are no good.

        • I think in general, the body has good reasons for putting hormones the way they are. So altering hormone levels directly is a bad idea. Altering some other aspect of diet or lifestyle in a way that adjusts hormone levels could be beneficial. But the place to look to see whether it is beneficial or not is not its effect on hormone levels, but its effect on health – mortality etc. That’s what we do in our book.

          No one’s done the studies to prove that hormone levels can be used as useful clinical biomarkers in the way that, say, blood lipids can be. That’s why they’re not in clinical use.

  50. I forgot to address this:
    What do you think of Danny Roddy’s criticisms of your diet including the following:

    May not be an optimal diet to treat hypothyroidism/chronic stress (inefficient glycogen storage, elevated free fatty acids).
    Insulin sensitivity may be compromised with a high fat and moderate starch intake (probably depends on stored PUFA).
    Weight gain seems to be a common on PHD (anecdotal forum chatter).
    Diet provides a high phosphate/calcium ratio.

    I believe you have already addressed the first one sufficiently.

    • Disagree with all of them, particularly the weight gain one. We’re an excellent weight loss diet, and an excellent hypothyroidism diet. Insulin sensitivity is not a parameter you want to go to extremes. The phosphorus-to-calcium ratio is largely set by bone broth soups, it is the natural human ratio. There’s plenty of evidence against the idea that one should lower the ratio by eating extra calcium (eg from egg shells as Danny does) – high calcium increases heart disease in many studies.

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