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. Real Food Eater

    Hey Paul,

    In your low carb series, you argue that glucose is only toxic under high amounts/extreme amounts. Can you elaborate? Would this only apply to diabetics? Stephan Guyanet cited a healthy group of Papua New Guinea highlanders who ate 90% of their diet as sweet potatoes. If they were healthy, when is glucose toxic?


    Real Food Eater

    • Hi RFE,

      There’s two issues with extreme high carb diets, lipid deficiencies (common on macrobiotic diet) and then any toxicity effects from disposal of excess glucose.

      I would expect some lifespan shortening from a very high carb diet. I don’t think the studies of New Guinea highlanders are sensitive enough to observe the health effects of high carb diets.

      • Real Food Eater

        Thanks Paul,

        I too by NO means feel that a high carb diet is unhealthy, just wanted your thoughts on it. As many paleo authors/bloggers have said, tolerable is not optimal; just because the Inuit survive on a zero-carb diet doesn’t mean we should be on a zero-carb diet, and just because New Guinea highlanders survive on a 90% carb diet doesn’t mean we should be on a 90% carb diet. Also, you mention on your blog that low protein diets are harmful and reduce human life-span/other animal’s life span. Are there any studies that strongly show this?

        -Real Food Eater

        • Chris Masterjohn has posted on this quite a bit. Check out his commentary on T Colin Campbell’s rat experiments.

          • Paul – is there a typo here? Isn’t it the case that high protein shortens lifespan? That’s what the PHD book says, I believe. There’s apparently evidence that life extension in calorie restricted animals is mostly due to restriction of one amino acid – methionine, which is one of the reasons only sufficient protein (~75-150 g) is recommended.

          • Hi David,

            High protein shortens maximum lifespan. Low protein makes you fragile to threats, esp toxins, which in the real world can shorten average lifespan. In the healthy middle ground of moderate protein, there’s a trade-off – lower protein will extend lifespan if everything goes well but might shorten it if things go badly.

  2. george henderson

    The New Guinea highlanders have low calory and protein intakes; basically they are adding calorie restriction and intermittent fasting to a diet that is (relatively) high in fibre and probiotics.
    These mean that the yield of protein and fat is enhanced in the process of digestion. But it is still a restricted diet.
    It’s possible that those hardships and other factors protect against high-carb harms; but does this consist of a diet and lifestyle that can be adapted to life in the USA, for example?

  3. Hi,

    I know you posted a mineral water recipe some time ago, but I’m unable to find it. Can anyone point me in the right direction?

    • Hi Ole,

      Try bone broth (calcium) with tomatoes (potassium), seaweed (various minerals) and salt (sodium, chlorine). The other missing mineral is magnesium … I suggested 1/4 tsp epsom salt for that but now I would just supplement 200 mg.

  4. Dear Paul,
    I am a 62 year old female whose rosacea is getting worse by the day. It has passed from the redness to the acne stage everything seems to trigger it, I have given up dairy, sugar, wheat, gluten for the past year but nothing seems to help in fact it is getting worse. The other problem I have is low blood sugar waking me up at night if I do not eat enough during the day. I have been following your diet the last few months and greatly appreciate all the help you are giving to your followers. I have read about the antibiotic “Rifaximin” (Xifaxan) and wondering your thoughts????
    P.S for the last 10 yrs. or so I have had chemical sensitivity to certain products.
    God Bless and Thank you.

    • Hi Mary Marcel,

      You should read the book Why stomach acid is good for you, written by Dr. Jonathan Wright. It has an entire chapter dedicated to rosacea, and its link with low stomach acid (I have some issues myself with stomach acid). You could look into that before using antibiotics.

      Good luck

      Juan Camilo

    • Hi Mary,

      First, I’d stop selenium supplementation, including a multivitamin. I’ll discuss why when I start blogging again.

      I would consider Rifaximin a last resort, and would prefer to see an infection diagnosed by a stool test before trying it.

  5. Hello Paul,

    I have read with interest ur website,even though i do not understand some of the more scientific ones..but my question is,I have asthma and have been on the paleo diet for a month now for weight lost purposes.All was good and I have managed to loose about 2kg in the month on paleo diet.I was very strict with only veges as my source for carbs at about 50g with no starches at all.As I am Asian,this was a burden for me as I eat rice alot!I found that although I feel good on this diet,ie less snoring,more alert n energy no more ringing in the ears at nite,BUT I was using my ventolin inhaler more frequently on this diet than previously.I tend to feel difficulty in breathing after eating n need to use my ventolin inhaler more.Does this relates to what u said regarding mucus production and the need to eat safe starches?Could this be the reason for me?Any help would be appreciated! Adib.

  6. Hi Paul,

    I have a couple of questions for you. I apologize if they’ve been answered before. 1) Unfortunately I just don’t have enough time in the day to make bone broth soups. Can I get similar benefits by taking beef gelatin as a supplement?
    2) I eat 2 egg yolks a day but no liver. Can I take a multi without worrying about getting too much vitamin A?


    • Hi Joan,

      1) We make it once a week, enough for about 3 bowls during the week. Beef gelatin replaces joint material / collagen, you might need some dairy for calcium.

      2) Yes, you can take a multi.

      • Thanks, Paul. I don’t tolerate dairy or dairy substitutes well, so I have to supplement calcium. Is 750mg/day a reasonable amount?

        • No. 750 mg is the optimal daily intake from all sources, including food. Most people get at least 300 mg from food, even you don’t eat dairy or green leafy vegetables or bone broth. So I would limit supplementation to 400 mg.

  7. I also use gelatin instead of broths and IIRC, Paul said it was okay.

  8. How strict do I need to be with this diet? Like two days in I was finishing a few leaves of lettuce on my daughter’s plate and I accidentley ate 1/4 of a crouton that was hiding. Should I have spit that out?

    Or if I’m out to eat do I need to ask the waiter to confirm that there’s no vegetable oil in anything I order?

    Basically if I slip here and there how much is it going to limit the positive effects of the diet?

    • Isaac, your comment made me laugh so much I almost spit out my coffee. You might find that eating out is the toughest part of the diet — I know I do.

    • Toxins are dose dependent but allergic reactions can be triggered by very small doses.

      So unless you know you are allergic to something, just avoid eating the toxins but don’t worry when you eat a little bit.

      Omega-6 oils can add up quickly though – a tablespoon commercial mayonnaise with “healthy oils” will net you 3g of Omega-6 oils. You want to keep your PUFA intake under 4% of calories so at 2500kcal that’s 11g, meaning that one tablespoon is 30% of your RDA and you need to leave some room for the O3 oils… So low-fat is the way to go when ordering out unless you know it’s butter and cream 🙂

    • Hi Isaac,

      Well, “the dose makes the poison” so unless you have celiac a crouton is not going to cause a problem. Similarly with omega-6 fat.

      We generally try to eat at home where we can assure all the ingredients are healthy but when traveling we eat at restaurants and don’t worry about it.

      I don’t think a slip is likely to matter unless it becomes the norm, or unless you have an allergic type condition.

  9. George Henderson

    Here is the relevant quote:

    here is a graph of adipose linoleic acid (circles) and plasma vitamin E (x’s) from one of their subjects:

    Even after five years of consuming safflower oil, having already come to constitute about half of this person’s fat stores, linoleic acid continued to accumulate in a linear fashion. Plasma vitamin E increased by 75 percent over the first year and a half, but then it began plummeting, finally leveling off towards the end of the third year after having lost two thirds of its initial increase. Although we would prefer to see aggregate data from all of the subjects, these changes suggest that vegetable oils initially provide an excess of vitamin E, but over time the continued accumulation of PUFA in adipose tissue imposes a tax on the supply of vitamin E as our fat stores demand more and more of it to protect their ever-growing supplies of linoleic acid from oxidation.

  10. Hi Paul,

    I’m wondering if you could solve a long-standing issue I’ve had with eating fatty foods. I have irritable bowel syndrome and eating all types of fatty foods tends to aggravate it. Fatty cuts of meat, overly greasy foods, and dairy. I would like to know why and how I can change this. I know fat is good and I am avoiding bad oils and grains (except for rice), so I’m wondering what is still causing the upset. Would digestive enzymes help, or just allowing my gut more time to heal so it is able to digest fat?

    • Hi Declan,

      I would guess the problem is endotoxemia. You might try experimenting with ox bile supplements or vitamin C and choline and taurine; maybe pancreatic enzymes with your meals. But I would guess it is a problem of inflammation due to endotoxin flux.

      I do think the main issue is gut healing and improving the flora / clearing infections. If you haven’t had a stool test for pathogens yet you might do that.

      It’s not a bad idea to eat more carbs and fewer fats. You might also try separating carbs and fats so that you don’t eat them at the same time.

  11. Hi, I hope that you can help me figure this out. I had stage 2 breast cancer and have made nutrition an extremely important part of my recovery. I eat relatively low carb paleo usually around 50% fat 25-30% carb ( a bit lower somedays) 25% protein. I have felt great and confident in my diet as healthy. However, reading some comments in your blog as thrown me into confusion. 1st you have stated that salmon consumption should be kept at no more than a 1lb a week, and that chicken is high in omega 6 so consumption should be limited, I buy grass fed beef from a local farmer and so I have been getting the majority of my protein from eggs, grass fed beef, fermented milk (1/2 to 1 cup a day) small amounts of grass fed pork , chicken about once a month and salmon and sardines 2-3 days most weeks. Also grass fed beef liver when i can get it. Today I read on your blog about neu5cg (?) and you suggested that cancer patients should stick with fish. I am no longer a patient but it worried me that I should not be eating red meat. But if not red meat, and not chicken and not pork and only one pound of salmon a week what should I be eating as a protein source? I want to eat the healthiest possible diet but what is that? I felt like I was doing all the right things and now I am questioning if I should even eat meat. Can you help me sort this out it would be much appreciated!

    • Hi T,

      I think beef is better than chicken or pork but not as good as fish for cancer patients.

      You do want to limit omega-3 intake, but most fish and shellfish have far less omega-3 than salmon. So have salmon once a week, but white fish, freshwater fish, shellfish, scallops, shrimp, etc most of the week. Eggs are fine also.

      I think it’s fine to eat beef, I’d just give preference to fish and shellfish if I had cancer.

      Best, Paul

  12. Hi!

    My doctor just gave me a prescription for Nystatin because he said what I thought was geographic tongue is indeed yeast! A friend of mine said he had candida issues and recommended doing a cleanse that is lemon juice, cayenne pepper and maple syrup. I have not yet taken the nystatin the doctor prescribed because I wanted to use natural products like oil of oregano, grapefruit seed extract, garlic and a few others. I am also hesitant to do the juicing diet because i think of all the sugar in the maple syrup will likely aggravate the candida…any help is appreciated

    • I agree about the maple syrup, I don’t think that’s a good remedy for Candida!

      Personally I would take the Nystatin, it stays in the digestive tract so it’s fairly safe. It rarely cures, but it can help.

      I’d mainly try to eat a healthy diet with extra vegetables. Salads (green leafy vegetables, onions, tomatoes, olive oil, balsamic vinegar) are full of anti-Candida foods.

      Best, Paul

      • George Henderson

        I agree about the nystatin. It is natural, does work, has no side effects beyond the “dying off” syndrome from the yeast (stuffy nose, headache, rash, nausea). But to retain the benefit, the diet has to do the rest; probiotics help too, and there is a “good yeast”;
        often included in anti-candida probiotics.
        The caprylic acid in coconut oil halps too.

      • Doesn’t balsamic vinegar contain yeast? Would that perform a gene exchange with candida?

  13. Hi Paul,

    I have been following a good phd for a while now and love it. The reason im contacting you today is because a friend of mine has a son that has suffered terrible eczema all of his life and he is only in his early teens. It currently covers his whole body except a small patch. They have tried everything the doctors throw at them. I have said diet is probably a good place to go. How should they deal with this extreme autoimmune response with diet in these early stages while its very acute. Thanks!

    • Hi Martin,

      You might look at the reader stories of Joan’s sister for an eczema cure.

      Eczema is a bit mysterious but it’s not necessarily autoimmune. I would consider it a probable infection until proven otherwise. In Joan’s sister’s case, it was something causing oxidative stress and creating an arachidonic acid deficiency, which caused the eczema. Antioxidant supplements helped a great deal.

      I would try a healthy diet and intermittent fasting, try antioxidant supplements, and see if your friend’s son can discern patterns that help diagnose the ultimate cause.

      Best, Paul

  14. Hi Paul, I am dealing with a Candida yeast infection. Of all the diets designed to control this, you are the only one that recommends starchy carbs. Where is the evidence that this way is better, as I saw a comment where you said lack of carbs increase the fungi, in my experience I seemed to control the yeast better when I was lower carb. Regards

    • Hi Jon,

      The evidence is simply that many people get systemic Candida infections when going very low carb and the infections recede when they add carbs.

      This makes sense because the immune system uses glucose against Candida and Candida can eat ketones and fat, so very low carb diets promote systemic fungal infections.

      However, if it’s a non-systemic epithelial infection (probably with a fungi other than Candida) then low-carb might help.

  15. Hi Paul. I would like to buy your book and try this diet however I don’t know how well it will work for me as I am a vegetarian. I do eat fish and, because I’m not vegan I do eat eggs and dairy (and fish), however the not eating soy or legumes really restricts my protein sources. Also, although I eat fish, I don’t like salmon,sardines, or most deep-water fatty fish so I supplement with fish oil, which I see you say not to do. Would it be possible to modify things at all or should I not buy the book?

    • Hi Diane,

      Well, we have a lot of nutrient-based information about how to eat a healthy diet, all of which is transferable to vegetarians. There is also a brief appendix for how to adapt it to a vegetarian diet, but most of the work in coming up with food ideas would be up to you. The fact that you do eat eggs, dairy, and fish makes it pretty easy. You can be perfectly healthy eating those foods plus vegetables.

      I think if you eat shellfish and some plant omega-3 sources, plus keep omega-6 very low, you can get by without salmon, sardines, or fish oil. But taking fish oil may make sense for you. If so I would recommend the liquid fish oils that you keep in the refrigerator.

      Best, Paul

  16. Aloha Paul,
    I love your book!
    If I am at ideal weight, fasting BS of 80-85, no health problems, what range should I accept after eating carbs (white rice in my nigiri?) I spike to around 160. I have been <50 Gms carbs for over eight months now and am worried about getting low thyroid-wise. (borderline normal now, TSH 3.5)
    Is there a rule of thumb on blood sugar range after eating? (I have a glucometer until I learn how I respond)
    Best, Catherine

    • Hi Catherine,

      Ideally the postprandial glucose would peak around 140 mg/dl and fall back to 100 mg/dl in 2 hours or so.

      Try putting vinegar in your rice … also as you eat more of it your blood sugar won’t rise as much.

      Best, Paul

      • After three days of adding only another 50 Gms of carbs,(total now 100 Gms) postprandial goes to 140, just as you said. (and I suddenly feel excellent!) I’m reading your book for the fourth time, it is really outstanding. Thanks for helping me get dialed in!!!
        That <50 Gms Carbs/ day was giving me a constant dull headache even eight months in.

  17. Hi Paul,

    Do you think, that sometimes , carb calories could come from winter squashes or sugary vegetables,rather than safe starches ? Or is it always better to have a small part of the diet coming from safe starches? What the “ideal” percentage you could advise ? Thanks ! Best, Maya

    • Hi Maya,

      Yes, it’s perfectly fine to get carbs from natural foods that have sugar. We eat beets regularly, for instance. Squashes are great – they actually are mostly starch. Sugary vegetables are fine too. Just avoid added fructose-containing sugar — added sweets should be safe starch based, like rice syrup.

      Ideal percentage — equal weights of safe starches and sugary vegetables. Since the starches have quite a bit more calories per pound, this makes the ratio around 80-85% glucose 15-20% fructose which is about optimal.

  18. Paul, I am dealing with a tinea versicolor infection in the groin area. Is this the same as candida? Should I eat more or less carbs with this kind of fungal infection? I read above that you mentioned less carbs for a non systemic epithelial infection. Do you mean ketogenic or just 200 calories from carbs? Is there anything else I can do?

    Also, I’ve read a lot about dairy causing autoimmune disorders and Chris Kresser talks about removing them along with nightshades and eggs for people with low t3 syndrome. Do you feel that dairy contributes to autoimmune disorders and needs to be removed? I tend to eat fermented dairy and a lot of sheep’s milk as opposed to cow, but my family is prone to arthritis and other conditions and I don’t want to develop them later.

    Lastly, is there any truth to acid/alkaline diets. I eat dairy/meats that are acid and I’m not sure that I always get the right balance. I think in Chinese medicine they consider dairy and certain meats to be very damp which can cause problems. Perhaps Shou-Ching knows more about this.

    • It’s unlikely to be Candida; there might be Candida mixed in with other fungi.

      I do think eating some carbs would be beneficial. I was thinking of the gut when I said carbs might cause trouble. They microbes would have to get the carbs before you do for the infection to benefit from moderate carbs.

      Dairy is a common food sensitivity and source of inflammation which might worsen an inflammatory condition. I think it’s worth testing them by temporarily removing them and seeing if you notice a difference.

      I don’t think the acid/alkaline balance per se is very important but it is desirable to get a balance of animal and plant foods for multiple reasons, so a good diet will tend to balance acid and alkaline foods.

  19. What do you think of oxaloacetate which is being sold by the Bulletproof Executive?


  20. What do you think about the progesterone excess that lies in modern dairy, due to most dairy cows being pregnant while they’re lactating. Would this be a cause for concern. What about dairy being linked to ovarian and other cancers?
    What about growth factors in dairy?

    • These are all valid concerns.

      However, I wouldn’t completely avoid fatty and fermented dairy just because of hormonal concerns. Butter has about 300 ng progesterone per gram, or 4.2 micrograms per tablespoon: http://www.ncbi.nlm.nih.gov/pubmed/1241645. Natural human production of progesterone is 20-25 mg/day (http://www.drlam.com/articles/progesterone.asp). So a tbsp of butter would provide 1/5000 of a day’s dose, or about 17 seconds production. I don’t think that’s going to perturb progesterone levels much.

      We recommend avoiding milk as a beverage, but eating fermented and fatty dairy like butter and yogurt. I think that’s a good compromise, given that dairy is so nutritious.

      • I agree. Thanks. I’ve recently looked at data that you mention and Ray Peat’s research on the matter of progesterone. It has been wrongfully targeted as a villain by the pharmaceutical estrogen companies that have their own agenda. It has been demonstrated to be not only cancer protective, but useful for fertility.

  21. Paul,

    I found this article on infections as the cause of autoimmune diseases, trough the impact they have on the Vitamin D modulator. http://autoimmunityresearch.org/preprints/Proal2010CellularMolecularImmunologyPreprint.pdf. It is extremely close to your hypothesis. I’d like to know your view on this. Thanks!


    • Hi Jo,

      I agree with nearly all of their analysis of diseases and microbe-vitamin D interactions, but I don’t trust the “in silico” computer modelling they do and don’t believe their proposed therapies are optimal.

  22. So you do not think discontinuing vitamin D supplementation (immunosuppressant) and using olmesartan instead (immunostimulation) is a viable option? In my experience low vitamin D is a consequence of something that also triggers my thyroid autoimmunity and even when vitamin D goes up as a result of supplementation I do not feel any better. Do you know of any therepy that like olmesartan can re-establish the production of proper vitamin D? Perhaps antibiotics can be used for this as well? I want to start experimenting something but I do not know where to start from. Will send the article to my doctor… !

    Thanks Paul, as usual, for engaging with all our questions


    • Hi Jo,

      No, I don’t think discontinuing vitamin D is a good idea (though I would limit D supplementation, especially in the summer). Also, I doubt that olmesartan is a good idea.

      I think the best course is to find the underlying infection(s) and treat those.

      You might want to read our vitamin D series, it has some information on why 25OHD is an active VDR ligand and promotes good immune function.

  23. I am going to read the Vitamin D series, thank you Paul. I am going to ask for more tests to find the infection(s), perhaps in this way I will be more listened to than if I start talking with my doctor of the Marshall Protocol.


  24. Hi Paul,

    I was just reading your conversation with Jo. My Vit D levels are getting lower and lower. According to my doctor my level should be above 50 (not sure what the measurement is) but mine was sitting at 25 then went down to 19 and is currently sitting at 17. I have tried many different supplements but they dont seem to help.
    Could this be due to due to some kind of infection ? Do you perhaps have some advice on how to go about finding out what infection it is ?

    Thanks for all your advice.

    • Hi Joia,

      If you getting sun and supplementing vitamin D, then I think an infection is likely.

      Have you had 1,25D tested? That is usually high in the infection scenario. I’d start with that. If they’re both low I’d try getting more sun/D.

      By the way, optimal for 25OHD is around 40 ng/ml, or 100 nmol/l.

      Infections are hard to diagnose if you lack obvious symptoms. A stool profile and antibody testing are the main methods.

      • george henderson

        Joia, I’m sure you’re all over this already, but magnesium is the co-factor for the Vit D hydroxylation reactions.
        And many vit D effects are synergistic with retinol and its metabolites.
        A reasonably good balance between vits A, D, and K seems important for any of them to work well over the long haul, and vit E needs to be factored in if the retinol has to be produced from carotene.
        I’d get a portion of my vit D from cod liver oil if I had concerns about Vit D efficacy. I suspect Paul’s not a big fan of CLO, but it’s a good way to top up Vit A after infections (CLO supplies approximately 10 units of retinol for one unit of vit D3). Something to use when needed, not necessarily 7/52.

      • This is interesting and somewhat discouraging. My own vit D levels fell from 55 to under 20 in the course of a year. (despite sun exposure and supplementation). I developed ulcerative colitis, a serious auto immune disease, in that time. I’m discouraged because in Canada you can’t get these tests done without a doctor (since the infection theory isn’t part of the accepted treatment protocol). Is there some self help way to at least halt the progression of the infection?

  25. Hello Paul,

    Thank you and Shou-Ching so very much for your work, which has been nothing short of life-altering for me. Even though I am not overweight I feared adding starches to my diet because I dropped most of the weight I gained during pregnancy on a LC paleo diet. When I did re-introduce the starches, I experienced a complete transformation — no mood swings, no cravings for sugar. Yay! I gained five pounds back but evened out and lost it slowly again.

    My question is: What, if any, modifications of the diet would you suggest for a nursing mother? Can I skip breakfast in the morning with just a coffee + cream, or is that not a good idea when nursing? I feel much better now that I’m no longer glucose-deficient, but am curious if your recommended macronutrient ratios change for women who are breastfeeding.

    Very best wishes and many thanks,


    • Thanks Kristen, it’s great to hear you’re doing well!

      I wouldn’t suggest many changes for a nursing mom. A little more energy in the form of starches and saturated fats (eg ice cream). Be sure to get adequate omega-3 fats. But basically, our standard diet is still best.

      Yes, you can skip breakfast. Follow your appetite and tastes. If you’re not hungry, you don’t need to eat. Coffee and cream is fine.

      Best, Paul

  26. Hi Paul,
    Good news! I just got my A1c tested and I’m now in the non-diabetic range– 5.5! This is the lowest it’s ever been for me (type 1 diabetic)!
    Bad news! I also had lots of thyroid tests done and it shows high levels of two of the thyroid antibodies. I’m not sure what to do! The doctor said that it looks fine for now and that its common in diabetics, but that we need to keep an eye on it to watch for thyroid disease. (ummm, how about we do something NOW instead!??)
    So here were my results:

    TSH-0.903 uIU/ml (range: 0.450- 4.500)
    Free T4- 1.26 ng/dl (range: 0.82- 1.77)
    Free T3- 2.6 pg/ml (range: 2.0- 4.4)

    Anti-Thyroid Antibodies:
    TPO/ Anti-Thyroid Peroxidase- 131 IU/ml (range: 0- 34)
    Thyroid Antithyroglobulin AB- 106 IU/ml (range: 0-40)

    Thyroid Stimulating Immunoglob- 150% (range: 0-139)

    Does this classify me as Hashimoto’s? I’m not sure what to try as far as diet. Could it be related to an allergy? I already cut out all gluten last October, but I do still have dairy daily. Or do I look at my Iodine intake? The salt I use is Real Salt which says 1/4 teaspoon contains 10% RDA of Iodine. Should I try omitting or changing the salt? I’m looking through the Thyroid posts here again because I’m not that familiar with the thyroid yet.

    Unfortunately, I can’t compare these results to anything because, other than TSH (and maybe T4?) I’ve never had the others tested.

    Paul, or anyone familiar with thyroid issues– any ideas? I’m willing to try anything! I’m not willing to let another organ go out of business.

    Thank you so much for all your help and time!

    • Hi KH,


      Those antibody levels are not all that high, and your TSH/T3/T4 are great. If you feel fine (ie don’t have symptoms of hypothyroidism), then I would agree with your doctor, it’s just something to watch and see if it gets worse or better.

      Since you never had those measured before, it’s quite likely they’ve been that way for a long time, and may even be improving on their own.

      I recommend supplementing iodine up to 1 mg / day. Our recommended supplements page has a low dose iodine, 225 mcg per tablet, try starting with one a day and increasing gradually.

      I think the salt is fine.

  27. Paul

    I wanted to tip you off to a recent news article:


    Linked documents from inside the ADA document a plan to require licenses to dispense dietary advice across the country, then using their members to file complaints about anyone offering non-licensed advice, to enforce a government-sponsored monopoly on telling people how to eat. We both know the kind of advice people would get under these conditions.

    You and I could both find ourselves on the wrong side of the law very quickly for helping as many people as we have. Please help to spread the word about this.

    Thanks again for your excellent work, and best of luck with your future endeavors!


  28. Quick update – The problem I was having with my feet flushing with warmth, and odd feelings in extremities has gone away. But strangely my best guess at this point is that it was LifeExtension’s Super K supplement causing it. Long story short, I experimented with taking/not taking the K and there seemed to be a correlation. I did not do a super-thorough test because the loose correlation was convincing enough for me to want to avoid it. I also seemed to have other effects from LE’s K, such as a feeling of hyper-activity after taking it one day when I had been off it for awhile. I know K is supposed to be very innocuous but it doesn’t seem so for me (at least that brand.)

    Something else perhaps of note – One day when I was taking K, and was perhaps well-stocked in other micro-nutrients, I experienced a sort of super-sensory awareness of the world. All my senses seemed much enhanced compared to usual. (Or perhaps that was “normal” and my usual condition is sub-sensory awareness..!)

  29. And one question – What do you (and/or others) think of KAL’s Trace Minerals? I ask because I don’t get beef liver frequently enough, or other nutrient dense foods. The thing that bothered me is it’s got B-12 (46mcg). Seemed odd to me.

    Link to ingredients-

    • George Henderson

      The B12 is there because it is the active form of cobalamin, an essential trace element.

      I’ve got to get me some of that LEF K!
      Vitamin K affects the brain by increasing sulfatide levels; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891353/
      Note that K1 is converted to K2 MK4 in the rat brain.
      It sounds as if your “Faculty X” experience
      was due to the restoration of youthful sulfatide levels. This would have been a one-off awareness of change; until the next time, perhaps.

      Low sulfatide content in brain myelin has been recently linked with the disruption of myelin integrity [14, 21], whereas the disruption of myelin integrity was implicated as an essential contributor to cognitive deficit [6, 7, 43, 44]. Although our findings of dietary-associated decreases in myelin sulfatides suggest a potential disruption in myelin integrity in evaluated brain regions, it is currently unknown whether such disruption would be sufficient to modify motor and cognitive functions controlled by these brain regions.
      The behavioral consequences of altered sulfatide concentrations through manipulation of dietary vitamin K remain to be assessed.

      • Re: B-12: So you would see no problem taking this supplement? On the supplement page Paul lists B-12 as “unnecessary [to supplement] in healthy people.” But perhaps 46mcg is negligible?

        The B vitamins seem like they have a lot of complex interactions with each other, so I’m a little hesitant to take non-food sources.

        Re: LE Super K: I did kind of give them an inadvertent sales pitch didn’t I? :mrgreen:

        Well it was an odd experience. When you mention “youthful sulfatide levels” – I think it did occur to me, “Is this how I used to feel as a kid all the time?” To me as an amateur investigator, it suggests that the K might have been fine when I have a good nutrient status, but that it might cause deficiencies in K’s co-factors when my nutrient profile is poor? Such as depleting Vit. A? Bleh, I don’t know enough to speculate.

  30. Paul and Shou-Ching,

    I’m in the middle of reading your book. I’ve lost around 80 lbs in the last couple of years through diet and exercise. The last 30lbs or so has been on a low carb/primal eating plan. After easily losing weight on low carb, I had plateaued and noticed that even small, small amounts of carbs would cause me to stall or even put on weight. I’d like to lose at least 50lbs more, so I started doing more research.

    I found your blog, got the book, and have been eating the primal health way most of the time for the last couple of months and have been doing relatively well. I haven’t lost a lot, but I know from looking in the mirror and from the comments of various people that my body is changing for the better and giving a slimmer appearance.

    Anyway, here’s the real question: I know that you advocate avoiding grains save white rice. While attempting to eat according to your recommendations, I had a dinner out where I chose to eat corn tortillas. The next day, the scale was down a bit. As an experiment, I’ve included some more corn products in my diet (in a couple of forms–cob, popcorn I pop at home in coconut oil, corn tortillas) and noticed that I’ve lost weight while doing this. Even stranger, I notice that when I stop including modest amounts of corn, I have a tendency to stall weight-wise. Is the inclusion of corn something I should stop because of toxins? Or should I keep doing what I’m doing for the time being because it’s working? I’m not in this just to lose weight–I want to eat in such a way that I’m healthy later into my life (I’m 29).

    I realize that you’re busy, so if you don’t have time to answer, no problem. Thanks!

    • Hi Amanda,

      Interesting. I guess I’d experiment and see if it’s more carbs that is helping or corn specifically.

      Interactions of food with gut bacteria matter in obesity and it could be something about the corn goes well with your gut flora. I wouldn’t put a lot of stock in that thought without evidence from the literature or other people.

      Corn does lack some of the worst grain toxins, eg no gluten, so it’s not a bad cheat food.

  31. Hi Paul and Shou-Ching,

    I just found out about you and your book/website through Chris Kresser. Wow – what a breath of fresh air! I don’t have to avoid white rice anymore! Your diet plan makes so much sense. I’m so excited for your new book and cookbook too!!!

    Two questions:
    1. I CRAVE white rice (I have hashimoto’s) and could eat it for all my meals. Have you run across this before? I eat a lot of sweet potatoes too.

    2. I also have a “few” blastocystis hominis in my gut – do you know of a way to get rid of them without antibiotics? I’ve done one round already but there are still a “few” (Metametrix’s definition) left. I’d prefer to not do the antibiotics again if I can get around it.

    Many thanks and again, LOVE your website and book!

    • Hi McCourt,


      Often when people are eating too low-carb they crave carbs.

      I don’t know of ways to get rid of blastocystis without antimicrobials, but sometimes just eating well and taking probiotics/fermented vegetables will help the immune system clear it. Optimizing vitamin D will help.

      Best, Paul

  32. I have begun my annual cycling in traning for an
    85 mile benefit and am wondering what you, or others, would recommend for a good drink to have during my rides and after. I have just completed a 42 mile training ride and would so love an ice cold glass of something. I’m not really craving anything, but my lawn chair. Sweetness such as orange juice sounds horrible. But rice syrup stirred in water sounds really good.

    I have a lot of miles ahead of me and would appreciate a PHD cooler suggestion.

    thanks, searched but could not find anything.

    dale (a biker chick)

    • We did a post on this … the best sugar mix for endurance exercise is 70% glucose 30% fructose or galactose … so rice syrup in milk would do it … some of the gel packs are about right … fruit juice with rice syrup is another possibility.

      • Thanks again, Paul, for your kind and prompt reply. I know that I had seen a discussion, but didn’t find anything when I tried a few terms in a search. The milk won’t do for carrying with me on my bike, but I could arrange to have it in a cooler along with the other drinks they supply other riders.

  33. According to my Kindle, I’m 62% through The Perfect Health Diet (which is excellent) and I’m in the section where it talks about each of the vitamins and minerals.

    One question I have is related to whether there are different maximums if all of the vitamins are from natural sources. For example, I ran a full day’s food through Nutritiondata.com and came out with some values like this:

    Vitamin A – 996% of DV
    Vitamin K – 1912% of DV

    I do take supplements, but mostly things like Turmeric, ginger, and Vitamin D – my multivitamin requires 3 pills per day, and I only take 1 every other day because I’ve seen how my diet is hitting >100% of DV on most nutrients.

    You can see the full breakdown at the link below. Appreciate any feedback.


    • Hi Kevin,

      I’d say you’re doing very well for micronutrients. Vitamin A don’t count the plant precursors, then it will be more normal.

      The major defects I see are too much PUFA (~8% of energy, we want it below 4-5%) – I’d say you could cut down on nuts and fish oil; and too much manganese – you might look at what’s raising that – it’s neurotoxic in high amounts.

      I’d agree you don’t need a multi. You might eat some more foods high in selenium: organ meats, shellfish.

    • Hi,

      I’m curious if the data should be normalized to 2000 calories. At 3267 calories would %DV be distorted … presumably energy expended is matching/near that level and the body would need more nutrients.


      • Thanks for the response.

        I should add that based on your book and reading more about nuts on Chris Kresser’s site, I’ve cut them back significantly. I’m replacing the calories with coconut oil.

        I looked at the manganese, and think that the main source was the nuts, so that should reduce that concern.

        Also, I’m dropping the fish oil, but do you have the same concerns for Krill Oil – as related to the oxidation? I’ve read where the astaxanthin in krill oil makes it much less susceptable to going rancid than fish oil pills.

      • Hi Mark,

        I don’t think nutrient needs go up linearly with metabolism. That’s why athletes can get away with more junk food / less nutrient dense foods than sedentary people.

        • george henderson

          Vitamin A DV is underestimated because excess alcohol makes retinol toxic, many people drink, and this cannot be controlled. DV is probably well below optimal for non-drinkers.
          Vit K DV is the minimum, because benefits of higher intakes are not appreciated; but who ever got diseases from overeating greens?

  34. Hi Paul,

    Would you mind commenting about rice cookers? It seems like they all have non stick interiors though they don’t say teflon. I’m looking at a Zojirushi brand. The reviews seem excellent.

    • We have a Zojirushi with anodized aluminum, which is fine until it gets scratched. I’d avoid teflon, but I’ve never seen a teflon rice cooker.

    • As far as I could figure out the only issue with Teflon is when it gets heated over 260C/500F, which is when it starts releasing fumes that kill your pet birds, make you dizzy and may or may not cause lasting damage to yourself.

      When using a rice cooker you won’t reach those temperatures because the surface is completely covered by water until the rice is cooked. (on pans it’s possible if you don’t move around the food enough)

      See also http://skeptics.stackexchange.com/questions/6232/is-non-stick-cookware-bad-for-your-health

      • Thanks to you both! The actual description for the Zojirushi rice cooker is just non stick. It was my assumption that this meant teflon.

        Wout, why are you more leery of non teflon, non stick surfaces?

        I’ve sent an email to Zojirushi and I’ll report back with what they say, just in case anyone else is interested.

        • I have the impression that real teflon is a lot more durable than the cheaper brands. I would expect that the formulation is different as well, and thus the temperature at which it starts outgassing.

        • I heard back from Zojirushi, but I can’t copy and paste their reply directly.

          All of their rice cookers have a non stick (PTFE) coating.

          PTFE is more or less, Teflon. Teflon is Dupont company’s brand name for PTFE.

          I’m going to agree with Wout that a rice cooker doesn’t get anywhere near the breakdown temperature, and also if it gets scratched, it should be replaced. Thanks again! Good discussion.

  35. Paul, I hear so many conflicting things on what foods to avoid for healing a leaky gut. I know the major ones like dairy and gluten, but is it necessary to remove nightshades? What about FODMAP vegetables?

    • Hi Theresa,

      The reason there’s so much variety is that people are different. The foods to avoid depends on where in the gut the problem is (small bowel where simple sugars are absorbed, lower bowel where complex carbohydrates are digested, colon where fiber is fermented) and the type of pathogen in your gut.

      FODMAPS are mostly indigestible sugars that are available to small intestinal microbes. More complex forms of fiber reach the colon.

      Some people are sensitive to nightshades, some aren’t.

      The best thing to do is experiment a little and close in yourself on what works best for you given your health condition.

      For colonic problems like IBS and ulcerative colitis, SCD and GAPS are good guides. For small bowel infections, you may do better with say potatoes than with the simple sugars like honey that GAPS recommends.

      Hope that helps!

      Best, Paul

      • Thank you, that’s very helpful. I got test results back from my doctor today, and I now know I have SIBO. I’ve long been told by other doctors I have IBS, but maybe this is the heart of the problem. Do I need to avoid fat while I have SIBO, or is some generally OK? Are there fruits that tend to be better tolerated by people with SIBO?

  36. Hi Paul & Shou-Ching…I know you recommend rice syrup as sweetener, but do you have a favorite brand/source? I have read that brown rice syrup can harbor high levels of arsenic, so I am wondering.

    And I can’t ell if you eve answered my query about miso – do you use it?

    • Hi David,

      Yes, we use miso, but in small quantities.

      Rice from the southern US where they used arsenic as a pesticide against boll weevils in the 1800s is the arsenic-laced rice. So you want brown rice syrup using rice from Asia or California. Lundgren’s uses California rice, that’s what is available in our local Whole Foods and what we buy.

  37. In that regard I follow PHD and a aid all food types as prescribed in the O blood type diet restrictions list and it works perfectly

  38. Can anyone recommend some good, high fat, yogurts and ice creams?

    Every time I go grocery shopping I check a few labels, get discouraged by all the sugar and end up not buying any.

    • I tried some Coconut Bliss the other day and thought it was good. It’s “ice cream” made from coconut milk. The only downside is it’s sweetened with agave syrup (ideally it would have rice syrup, or even cane sugar, instead). It is fairly high in fat though, with most of it being saturated fat since it’s made from coconut milk.

      • You can very easily make ice cream by melting chocolate into coconut milk and putting that in an ice cream maker…

  39. Hi Paul, I am from BC, Canada and came across you via Dr. Mercola’s site (I have been reading and ordering from him for a couple of years now) I am a bit confused as to the book ordering, do you have a first edition not available in Canada with a second one coming Dec 2012? I want to try your eating plan however I dont have alot of info and what I am getting is mostly from this Q&A site.
    I am struggling with extra weight (50lbs on a 5’3″) frame and although I realize you are adding more weightloss info to your book, I was really needing to do something ASAP as my energy is zapped. I also want to start Dr. Mercola’s workout plan and the peak 8 ( which I am sure you know of) is probably going to be much easier if my weight is down and my energy up. Right now it seems as soon as I lower my carbs and eat healthier, I feel dizzy and slow not to mention a little bit moody. I know I have a low thyroid 4.7 and am on a 15mg dose of thyroid but if I go any higher I feel too anxious and cant settle down. I don’t do well with caffeine for the same reason. I have yoyo dieted for most of my adult life and so now I think I messed up my metabolism and could sure use some advice. I downloaded your free info (thank you!) however it would be nice to have your book to follow.
    Thanks so much, for the first time I have found a nutritional plan that makes sense and from what i read so far, encompasses most of my fav foods…except maybe the organ meats…that might be a stretch for me 🙁

    • Hi Jennifer,

      Our current edition is available in Canada, here’s the amazon page: http://www.amazon.ca/Perfect-Health-Diet-Youthful-Vitality/dp/0982720904/ref=sr_1_1?ie=UTF8&qid=1342120481&sr=8-1

      The new edition will be available in December.

      Try using the custom Google search box to find our “weight loss version” post and also read the Obesity category starting at the beginning.

      Thyroid recovery is important and will help you lose weight.

      Re exercising, Dr Mercola’s plan is excellent but if it’s too strenuous when starting, the first key is to go out and do light activity twice a day – once in the early morning and once mid-day or afternoon – walking, jogging, skipping. Be religious about it. This is not for fitness, but to re-set circadian rhythms, which physical activity does, but it doesn’t need to be intense – jogging slowly for 10 minutes is a good start.

      After a while, as your health improves, you’ll find your ability and desire to exercise improving.

      • Hi Paul, I got your book in the mail a few days ago and am very pleased. I have read so many books on nutrition, fad diets, you name it. I began eating more paleo about 2 weeks ago (as I thought it would give me a jump start to your program) I have to say I have lost a clothing size and feel great except I am struggling with the low carb dizzyness and am not sure how to fix that. I am still trying to figure out the perfect ratio for me and I have reduced the fat % as you mention on the weightloss blog, but I am a little concerned about the brain fog. Could this be something that my body is just adjusting to? Like a withdrawal symptom from the high carb diet I was consuming prior? I also suffer from bouts of vertigo that come about 3 or 4 times a year. At first I thought it was due to water in the ear or a neck injury however now I am starting to wonder if it could be something going on with my nutrition…have you ever heard of that possibility? You mentioned in the other blog that you would like those of us trying to lose weight to keep you posted, would you prefer me to use that site and would you still like us to give updates on our progress? I am looking forward to the revised edition in December, in the mean time I will keep studying your book as I am a little confused with the science behind this diet. If you can recommend a sample menu for weightloss that would be so appreciated! Thanks for your amazing insight into an issue I have been left to puzzle over for years!
        Jennifer 🙂

  40. Hi. I’m a newbie who has been eating primal for a while for Hashimoto’s. Then progressed to elimination diet after sensitivities and gut issues developed with many hard to digest foods. Now that I feel better with all that I love your info on safe starches and the lower protein. It has been bothering me to be so protein heavy each meal just somi won’t get hungry. I was wondering if red, new potatoes are ok? It seems you say white potatoes. Reds have starch but no sugar. I’d love to know. Also, is it ok to eat rice for breakfast with like warm coconut milk and butter, cinnamon? Kind of like warm rice pudding? No sugar, of course.


    • Coconut milk rice pudding is delicious! I make and eat it simply like normal rice pudding.

      The tricky part is getting the consistency right, depending on the coconut milk you use you need to add more or less water near the end.

      It’s quite heavy so eat slowly so your body has time to realize what’s coming down the pipe 🙂

    • Hi Jan,

      Yes, red skin potatoes are great. I think white refers to the flesh, not the skin.

      Rice pudding is a fine dish! If that’s your taste for breakfast, that’s quite alright. We have it mostly as a dessert.

  41. Did you guys see this article from the NY Times or read about the study? I’m guessing you weren’t surprised by the results. This made me feel even better about choosing this diet.


    • Very interesting. The study is here:

      Too bad that the low fat and low glycemic versions both had more actual carbs (310g, 205g, respectively) than advocated by the even the non-weight loss PHD version.

      Total calories were 2150kcal for the run-in and 2000kcal for the test diets. Low fat was 60/20/20 Carb/Fat/Protein by energy, low glycemic was 40/40/20 and low carb was 10/60/30; run-in was 43/.

    • Very interesting. The study is here:

      The macronutrient ratios they tested: Low fat was 60/20/20 Carb/Fat/Protein by energy, low glycemic was 40/40/20 and low carb was 10/60/30; run-in diet was 45/30/25.

      So it’s hard to tell if the extra energy expenditure is because of the low carb or because of the rather high protein. Note that the “low fat” diet would have to be 1000kcal or less in order to keep carbs below 150g/day – madness.

      PHD is around 15/70/15, with the weight-loss version becoming lower fat e.g. at 1800kcal it would be around 17/66/17 (based on a fixed base of 600kcal carb+protein). So in that light it looks like PHD is an excellent weight loss diet 🙂

  42. Hello, I am finding this website fascinating. I am sure this question has been answered time and time again. My dr is treating me for hypothyroid and high cholesterol (254), low vitamin D, estrogen dominat and low progesterone. Would like to loose approx 10-15 lbs. I am now taking Armour thyroid instead of Levothyroxine and Cytomel, and progesterone tablets, as well as a host of supplements. She is pro Gary Taubes and Wheat Belly, both of which have good points. She has recently talked me into no or low carbs, but I find that extremely hard. I like your approach much better. Please give me the “readers digest” version or 1st grade version of how eating safe starches is better. Will PHD help me with my conditions? Any advise would be greatly appreciated.

    • Hi arlenena,

      see http://perfecthealthdiet.com/2011/11/safe-starches-symposium-dr-ron-rosedale/ for a discussion on starches.

      254 is only a little high, see http://perfecthealthdiet.com/2011/07/serum-cholesterol-among-hunter-gatherers-conclusion/

      As for your thyroid, it could be an autoimmune condition so eating for optimal gut health is important as well as providing enough nutrients. See http://perfecthealthdiet.com/q-a/comment-page-27/#comment-84143 and read everything under http://perfecthealthdiet.com/category/disease/hypothyroidism/ 🙂

      PS: I’m not Paul and it’s the Jaminet’s site and book, I’m just a fan that tries to give Paul more time to work on his book 🙂

      • Thank you so much Wout for your help, still I am so confused! I read the links you provided and I might be even more confused. Not your fault, I just don’t understand all the scientific talk. I guess I need the PERFECT HEALTH DIET FOR DUMMIES! The link jimmy Moore conversation about safe starches really did me in. I just really need someone to explain just a little. I don’t have diabetes so not that worried about adding a few potatoes here and there. It is just hard thinking like this when “low carb” has been drilled in everyones head……

    • Hi arlenena,

      In general the body will utilize ~600 calories glucose per day regardless of what you eat; if you don’t eat carbs it will have to manufacture it from protein or shut down beneficial activities; manufacture is stressful, especially if you don’t eat extra protein. The lowest stress diet for your body is to supply macronutrients in exactly the proportions the body wants to use – which works out to maybe 30% carb 15% protein 55% fat. Lower or higher carb diets create stresses by requiring either glucose manufacture or disposal. Sometimes things go wrong and the body isn’t able to handle those stresses properly.

      Yes, I think PHD is good for your conditions.

      • Thank you so much for your reply! I have pre-ordered your book and can’t wait to get it and show it to my dr. Any pointers on how to get her attention. In the meantime can you give me an example menu for breakfast, lunch, and dinner. It is so hard for me to comprehend this way of thinking. After being drilled so heavily……

        • I am reading the book and addicted to the Q&A’s. I have been trying to follow the PHD and still learning the new way to eat. I have not had any grains or sugar (only stevia), so I think I am on the right path. I can say I’m doing all the DONT’S but not doing all the DO’s… Not any organ meats yet (UGH). So far not missing bread or sugar. I feel a little anxious or nervous and really tired most of the day. I am sleeping good at night. Like I mention above low thyroid take armor and I also take progesterone. I am taking most of the recommended supplements but was wondering your thoughts on pharma grade vitamins and minerals. Are they better? Also, I am not loosing any weight, can you give me suggestions on THAT. I assume my adrenals are off too. Any help would be greatly appreciated.

  43. Hi Paul,

    Does NAC kill or help destroy good bacteria? (Just got a fecal transplant and don’t want bacteria to die off by taking NAC.)

    • Hi Acai,

      I don’t think it bothers good bacteria. First, it is mainly absorbed in the small intestine and good bacteria live in the colon. Second, the reason NAC is antimicrobial is (a) it supports glutathione synthesis in immune cells which is an antioxidant helping immune cells kill microbes, and (b) it helps break disulfide bonds which help defend bacteria against immune attack. But the immune system is not attacking gut bacteria, so it would harm them much even if it reaches the colon.

  44. Paul,

    I have read your book as well as a few others in a similiar realm, and this way of eating really is perfect for me. Especially since i have always believed tubers are excellent nutrition as they grow in the grow and absorb so many minerals. Which leads me to my question. I had radioactive iodine over a decade ago for grave’s disease. Ioidine is a critical mineral, but There are so many conflicting opinions on whether supplementation for someone with no thyroid is worth the bother.

    I would love you to answer the question, but give some details on why it is or isn’t important for people without a thyroid!

    Much appreciated,

    • Hi Amy,

      Yes, I definitely think it’s good to supplement iodine. Actually the biggest danger of iodine is that it may disturb the thyroid, so you may have more reason to supplement iodine than others.

      Do you have thyroid function left? If so, it that’s another reason to supplement at least a low dose. Iodine is protective against Graves disease.

      • Thanks Paul, I appreciate your reply and look forward to your new book.

        To answer your question, no I have no thyroid. Would you recommend a higher dose because of this? I use Himalayan sea salt a few times a week, that is suppose to have iodine.

        Also, funny enough I started being very strict with my diet and eating more red meat, less carbs and my T3 tanked…my doctor had no idea why! I read your other comments and found that interesting fact. Wish more main stream doctors were as knowledgable as you!

        • Yes, I would take a high dose of iodine if I had no thyroid. But I’m not aware of any studies testing it, and sometimes biology surprises us. So I would periodically try stopping the iodine and see if you feel better or worse.

  45. Thanks Paul! I’m doing well on the addition of safe starches and less protein. Whew…like a breath of fresh air! Just the smell of the rice cooking was intoxicating.:-)

    I have one additional question. I would like to drink green juice that I make for a “snack” type serving. I cannot take the fiber of blender-made juices or eating raw veggies. I steam or roast most veggies. If I use celery, carrot, ginger, spinach, kale type ingredients, would that be ok? I would not do fruit juice.



  46. I have a strange question for Paul or anyone else with relevant experience. I have noticed dramatic health improvements after only a week of using a sleep mask. It’s really remarkable. For years I have slept in apartment rooms that let in a ton of light from the outside, but I now want to buy some blackout curtains (the sleep mask can be a little bit uncomfortable when trying to fall asleep). Has anyone had a positive experience with a specific brand of blackout curtains? I gather there is a lot of variability in the quality.

    • Improving circadian rhythms does have a big impact on health. We’re including a chapter on that in the new book.

      But I can’t advise you on particular brands of curtains. We got the most opaque drapes we could find in our local stores.

      • Paul (or anyone), I’ve wondered this for a while: sleeping inside is seemingly a relatively modern thing. I presume caves for much longer than houses, but I doubt, evolutionarily speaking, that the bulk of our sleeping eons have been inside. (Note this is a doubt, versus any point of legitimacy.)

        Anyway: sleeping outside is hardly pitch black. Why the argument for such an environment indoors? Or are we merely considering unnatural light as significantly negative vs. starlight?

    • Regarding the blackout curtains, you should be able to get blackout fabric at most crafts stores. Joanns by me has it:


      (When I went to Joanns looking to make blackout curtains, I was armed with a powerful flashlight and testing the opacity of various fabrics. One of the workers eventually took me to the blackout fabric. Blackout indeed, 100% opaque!)

      • The light issue at night is about the light spectrum. It is blue light or as we know it white light, that tells the brain it’s “daytime/sunlight”. The night light is in the yellow spectrum, like “stars”. If I work on my computer or watch tv after dark, I wear a pair of blu blocker sunglasses, which I bought online (amazon). They block the blue spectrum light that at night keeps us from being able to fall asleep. Electronic light/led light at night comes through the lids and tells the brain it’s daylight. That’s why the blindfold helps. You can also use yellow spectrum light bulbs like in the bedroom for night use.

        Happy sleeping.


        • george henderson

          You also have to factor in man’s long-standing dependence on fire; we had to keep them glowing and they often supplied safety and warmth through the night. So a properly-designed nightlight, with frequencies of light resembling fire (the yellow spectrum?), might even be better than darkness for some people?

          • Likewise I have to wonder why children fall asleep so easily in a moving car – was the roaring of the fire a sign of safety?
            It is easy to imagine that any adaptation making our use of fire more likely would have been highly selected for, fire being such a powerful tool for ancient man.

  47. Hi Paul. I’m back. The more I get into the PHD and its effect on Hashimoto’s I end up with more questions. Since eating according to the PHD over the past 3 days,I feel much better overall. However, without making any changes to my t4/t3 doses, my temps seem to have dropped especially from late afternoon through the night. Just wondering if there’s any connection to adding carbs and activity of t3 in particular? Hate to increase and run into hyper symptoms. Thinking maybe after a bit on this diet things may improve? Any experience with this one?



    • Hi Jan,

      Well, you may need to adjust your dose a bit. But it can take the thyroid 3-4 weeks to adapt to a new dietary regime, so you do want to make changes gradually.

      The body will suppress T3 levels on low-carb diets, so adding carbs will tend to increase T3 production. Usually however I wouldn’t expect that to mean that you need to supplement more hormone, unless your thyroid is really dysfunctional.

  48. You mention in the book to focus on heavy cream and cheese when speaking about milk, but also mention that lactose breaks into glucose and galactose, which are both safe sugars. Can we replace some of the starches with milk? (I only drink raw unhomogonized milk, as pasteurized milk upsets my stomach.

    • Hi Amandal.p,

      I don’t have strong feelings either way about milk. It has potential problems but in other respects is almost a perfect food (as, indeed, human milk is for human infants).

      Proteins are relatively more problematic than sugars or fats, that is why we recommend fatty or fermented dairy more than milk. But if you feel you handle it, it’s not necessarily bad in moderation.

  49. Hi Paul

    I had been to a naturopath today. He thinks my gastritis and constipation issues are due to weak thyroid and pancreas ( possibly due to prolonged use of metformin to treat PCOS) and Candida yeast infection:(
    He wants me to go thru a deep cleanse and take digestive enzyme supplements with candida cleanse homeopathic medicine. As i was already eating clean per PHD he dint have much to change in diet. He has recommended to avoid dairy fermented foods and acidic foods. He recommends apple cider vinegar.
    Is this condition of mine curable? How much can dietary changes help


    • Hi Koki,

      It’s certainly curable. I’m not sure if your naturopath’s approach is best but I hope it works.

      Best, Paul

      • Paul
        Kindly suggest the best approach. The naturopath recommends stopping metformin and my prenatal vitamins . The whole treatment is not cocered by insurance so I want to get it done the right way the first time. Please suggest your best solution to cure this issue. The doc determined the issues as weak thyroid, pancreas and candida by tongue reading and chi point testing. The labwork is yet to be done.

        • Hi Koki,

          It’s impossible for me to say what the best approach is; but there are diagnostic tests and clinical procedures for all of the conditions you’ve mentioned. What is “weak thyroid” – hypothyroidism? What are the symptoms of Candida? What other infections may you have? Have you been tested for gut infections (stool test, maybe SIBO tests)?

          Have you read our constipation post and tried the nutritional supplements etc there? If you are hypothyroid, why not treat it with thyroid hormone?

          I would also try circadian rhythm therapies – how are you sleeping? Do you exercise during the day? Get lots of bright light in the day, little light at night? Finish eating around sunset? Get sun exposure in early morning and afternoon?

          The naturopath’s ideas may be correct, I’m not saying his diagnosis is wrong. Hypothyroidism causes constipation and gastric dismobility (http://www.ncbi.nlm.nih.gov/pubmed/20351569); but it puzzles me why, if that is the cause, it’s not being treated directly. Candida can also be a factor. I found lufenuron and fluconazole helpful for Candida, others have found nystatin helpful when it is a gut infection. Perhaps pancreatic enzymes are all that is needed to treat an infection. I don’t know.

          • 😐

            Thanks for the reply. The naturopath is sending me for blood work to confirm thyroid issues on monday. I will discuss with him about treating with hormones after the results are obtained. I had doubts abt thyroid as I have been loosing weight 10 + lbs in last 2 months , constipation and cery heavy menstrual bleeding. He felt it was due to weak thyroid . I guess he means hypothyroidism.

            He saw my tongue and did chi point testing and says I have candida . I asked him for stool test. He said its expensive and not covered under insurance. With his exoerience he says its candida and says lets spend money on treating it rather on stool tests. He has put me on digestive enzymes supplements and parasite cleaning supplements. He will get me a homeopathic medicine for candida next week. He had put me on an organic raw food diet to alkalinize ny system and advised me to drink only alkaline water. I

            I read in a post in your site where you mentioned that lemon is alkalinsing and hence is candida friendly so go for vinegar. I am confused … Why does my doc want me on alkalinised diet?

            I did not supplement anything other than magnesium from your recommendation as I am already taking a lot of new supplements.

            I sleep ok. Walking in the evening lifting my baby and running behind my 4 year is the only exercises I do
            I am trying to improve that.

          • I am still nursing my baby so that complicates taking medications

          • Hi Koki,

            Lemon juice is alkalinizing, vinegar acidifying. Both are healthy. Balsamic vinegar works against Candida in the gut, I’m not aware offhand that lemon juice will have a significant anti-Candida effect, but it is generally a good thing to take.

          • Paul
            Thanks a million Paul. Your patience and knowledge amaze me
            What are the no- nos for an anti candida diet? Is coconut , coconut oil and coconut milk useful against candida? I find controversial info on them

  50. Paul

    Kindly suggest the best approach. The naturopath recommends stopping metformin and my prenatal vitamins . The whole treatment is not cocered by insurance so I want to get it done the right way the first time. Please suggest your best solution to cure this issue. The doc determined the issues as weak thyroid, pancreas and candida by tongue reading and chi point testing. The labwork is yet to be done.


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