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. My question is in regards to food sensitivities, hives, acne, and constipation.

    I am a 25 year old female. I was on birth control pills roughly from 14-23. About March of 2011 I started slowly transitioning to a “Paleo” diet. By November, I decided to slowly cut dairy. February of 2012, I cut fruit to attempt an anti-candida diet. In March I started GAPs and eating broth and fermented foods.

    Starting roughly around March, I started getting hives…at first only while I was sleeping (a few small ones on my legs when I woke up), then increasingly larger and also on my arms, butt, and lower back related to heat…sleeping under covers, hot baths, sauna, etc. It does seem like some foods aggravate it but I havn’t 100% narrowed it down…potentially magnesium supplements, apple cider vinegar, cod liver oil, and possibly the broth or ferments aggravate it giving me massive itchy patches. Very hard to narrow down.

    I started GAPs due to digestive issues and adult acne. It has gotten better since GAPs, but I still have skin issues that seem to worsen after eating (they look like little white patches around my cheek bones and very sides of my face, they seem to get puffier after I eat, don’t always break out into full on pimples, and I have blackheads on my forehead too).

    I also have never been regular since as far back and I can remember. I currently eat nothing but meats, veggies, and coconut and olive oil. I was eating Kerrygold butter as my only dairy, but I stopped about 2 weeks ago (my acne hasn’t gotten better in that time). I tried reintroducing some yogurt but got very bloated and sometimes nauseous. I IF every night for about 14 hours. I have been trying to up my carb intake (from about 50G to 100G) by eating my winter squash and carrots, also had a sweet potato and banana last week, and my skin seems to be worsening again. My stomach also looks bloated to me every time I eat, even if it isnt a huge amount.

    I obviously have an elimination/detox issue, food sensitivities but I don’t know what to do at this point because being low carb is leaving me skinny with lower energy levels, but adding more carbs is messing with my skin, and still my energy levels in a different way and I’ve been a bit moodier too. Sorry this is so long but I have experimented so much I am at my wits end, please help!

    • Hi Elyse,

      I don’t think it’s a good idea to eat such a low-carb ketogenic diet routinely. It makes you vulnerable to fungal and protozoal and parasitic infections and impairs certain functions and creates adrenal stress. It’s OK as a temporary measure to deal with digestive tract issues if it doesn’t cause negative symptoms, but in your case I would try to add carbs back and take less coconut oil.

      Have you gotten a stool test to see what may be causing these issues?

      • Hi Paul thank you for much for your response. How much coconut oil per day do you think I can have? I was a binge eater in the past highly addicted to sweets. My cravings for sweets have not completely diminished, though it is different now that I do not allow any indulgences-so with the pumpkin, kabocha, carrot, and butternut squash I’ve been reintroducing, I obsess over when I can eat them next, which worries me. Should I try to eat carbs like this every day, or can I cycle with higher carb days corresponding with physical activity, and lower carb days with regular vegetables, and should I try more potatoes despite my skin condition seeming to respond negatively to this increase in starchier carbs?

        Can you please advise what sort of practitioner I should seek and what to ask for as far as a stool test would go? Thank you again for giving me some direction, I am tired of the conflicting information.

        • Hi Elyse,

          I think butter/sour cream would be better than coconut oil. A bit of coconut milk would be fine. I would try to eat carbs every day, but it’s fine to cycle them.

          The stool test that I like best is the Metametrix microbial ecology profile. Any health practitioner can order it, eg your doctor.

          • Ok may I ask whats so bad about coco oil, and you think I should just push through the dairy intolerance? Thanks much!

          • Hi Elyse,

            Sorry, I forgot about the dairy intolerance. In that case it would be good to find a local farmer and get some beef tallow, or clarify the butter (or buy ghee).

            The problem with the coconut oil is it is ketogenic and that appears to be giving you problems.

          • Interesting, do you believe ketosis could be causing the hives as opposed to a bacterial or fungal infection of some kind? It’ll be awhile before I can take a stool test but will look into it soon. =)

          • I think if ketosis is causing the hives it will be through feeding a fungal or protozoal or worm infection or impairing the immune defenses against them.

  2. Metametrix results today, but very late and early morning ahead. Several numbers I would like to share, but it’s so late, I’ll share only this one for now.

    Helicobacter pylori was “7.2E+005” with the red “H” indicating “high.”

    I have no symptoms and doc is surprised at this. Feels an herbal treatment might be the treatment of choice, considering the damage of antibiotics. Suggests Thorne SF 734.

    Do you have an opinion?

    Paul, thank you for your discussion in Dallas of the infection possibility. I would never have thought of it and no doc has ever suggested it. This test was a direct result of attending your presentation that day.

    • Hi Lana,

      I don’t like to give opinions on treatment, I lack the clinical experience needed to form informed judgments. There is a standard antibiotic treatment for H pylori. I don’t know how well the herbal treatment works.

      But I hope whatever treatment you choose cures your problems! Thanks for writing, Lana.

      • I’m sorry to have put you on the spot, Paul. I didn’t want to do that. Just so disconcerted after reading about this nasty thing. It is because I don’t have traditional symptoms that the doc is suggesting the Thorne formula. Sean Croxton says none of his clients has failed to recover from H. Pylori after a month of Matula tea.

        Much of the emotional difficulty for me is the suggestion that I may have had this since my own childhood, likely have spread it to my children, who are now adults and have their own children, who are likely also contaminated. I know I have to tell everyone, but I have this terrible sense of being “Typhoid Mary.”

        I have ordered the Thorne formula. In the meantime, I search and stew. Here is an article that suggests a connection with forms of arthritis (calcification and spurs), iron def anemia, Vit B12 def, and low stomach acid (all of which I have, or have had).

        Here is that article: http://www.acu-cell.com/dis-hpy.html

        This is a presentation by a University of WA scientist, presenting to lay people, so it may not be new information: http://www.youtube.com/watch?feature=endscreen&v=tpQ8XzBiAgQ&NR=1

        One scientist asserted that H. Pylori is ubiquitous and even flies carry it. This seems to be easier to hear than the possibility that I have had it for decades.

        Shouldn’t the endoscopy I had several years ago have shown this infection?

        • Hi Lana,

          I don’t think you should be concerned about your children. H pylori infection is very common. If they didn’t get it from you, they would have gotten it from someone else. In most people it doesn’t overgrow to such an extent that it causes serious issues. It probably needs something else to go wrong to allow it to overgrow.

          Definitely H pylori can cause a lot of problems if it does become systemic. It is a cancer risk too so it is good you are trying to treat it.

          Endoscopy will catch stomach ulcers or small bowel ulcers which H pylori can cause, but infections can produce a variety of effects and so it’s not guaranteed that an endoscopy will catch an infection.

  3. I never heard this term before, ‘acellular carbohydrates’: http://www.marksdailyapple.com/weekend-link-love-198

    • Hi tam,

      Yes, interesting paper. I think there are some other possibilities that would explain the problem with industrially prepared grain products and sugars, but the acellular nature is an intriguing possibility.

  4. Dear PHD Community,

    I don’t have a question exactly, just wanted to post this link to a “success story” on MDA and see if anyone else is disturbed by the guy’s cholesterol changes. He began a Primal/Paleo diet and obviously experienced some great benefits (weight loss, more engergy) but his cholesterol profile shows that things may not be right, based on Paul’s research. The commenters and the author are celebrating the author’s seemingly stellar lab results, of course.



  5. Hey Paul,

    You may recall that I’ve commented on my efforts to resolve some chronic health problems a few times over the course of the past couple of years.

    Everything has been shaping up nicely, with the exception of one thing: I have persistently (very) low cholesterol, never higher than 150.

    You’ve mentioned in a few places that a protozoal parasite or worm infection could be the cause of that, and indeed I did test positive for entamoeba and whipworm a few months ago.

    However, I treated both and subsequent stool tests have been negative, but my cholesterol remains as low as before and sometimes lower.

    I eat a tremendous amount of saturated fat and dietary cholesterol, and I usually make a specific effort to eat at least 3-5 egg yolks per day, and this seems to make me feel better and has increased my total cholesterol from under 100 to the 130-150 range. But I cannot seem to get any higher than that no matter what I eat.

    I am euthyroid, lean, otherwise healthy in most respects, young, etc. My only remaining symptoms are intermittent anxiety, depression, and poor stress tolerance, all of which have been linked to low cholesterol.

    Here are my theories as to why this is still a problem:

    1) I am a carrier of the Smith-Lemli-Opitz gene, which limits my ability to synthesize cholesterol regardless of my diet or infection status.

    If this is the case, the best treatment would apparently be cholesterol supplementation, but I cannot tolerate the only available cholesterol supplement. I’m not sure why, I just feel awful every time I take it.

    2) I have a systemic protozoal infection or a recalcitrant gut infection that has evaded detection on follow-up stool tests.

    3) ???

    I know this is a long comment, and I apologize for that, but would you be willing to comment on this situation and perhaps offer some suggestions?

    Thank you so much.

    • Hi Brendan,

      Those two do seem like the most likely possibilities. The third possibility I can think of is hyperthyroidism, but you say you are euthyroid.

      I would suspect an occult infection remains; that would explain why you feel bad when supplementing cholesterol.

      So I would ask for a referral to an infectious disease specialist who might know what blood tests or other diagnostic tests could be run. The infection is probably systemic because it is pulling cholesterol from the blood. Often the same germs that infected the gut are present systemically but sometimes the systemic pathogens are different.

      Best, Paul

      • Hey Paul,

        Thanks for responding.

        I’m willing to entertain the possibility that I have a systemic infection of some kind, but I’m still not convinced this is the case.

        I think it’s possible that I react badly to cholesterol supplementation because of the binders and fillers used in the supplement. I tend to react to common fillers like cellulose, magnesium stearate, etc. I was taking the cholesterol supplement in enormous doses (8-16 capsules of the stuff), so it’s possible that I’m just reacting badly to such a large quantity of the fillers. I haven’t tried eating egg yolks, for example, in amounts large enough to provide the same dose of cholesterol.

        And in over a year of visiting various doctors, I haven’t been able to find a single one that is willing to take me seriously when I start talking about systemic infections and their connection to mental health. I wish I could get the necessary tests off of DirectLabs, but they don’t carry such specialized tests.

        Anyway, it’s still possible that the best-case hypothesis is true–i.e. that I simply have a genetic defect in cholesterol synthesis and no remaining infections.

        Thanks for your help, as always. I’ll keep you posted if and when I get this figured out!

      • A few more questions:

        Just to clarify, are you implying that the occult infection feeds on cholesterol, and thus supplementing cholesterol would increase the activity of the pathogen, worsening symptoms?

        If more cholesterol does indeed worsen symptoms, would this indicate that the pathogen is likely protozoal rather than bacterial, fungal, or viral?

        If we assume that I do NOT have an occult infection but rather have a simple genetic defect in cholesterol synthesis, finding a way to consume more cholesterol would be a really good idea, right?

        Thanks again!

        • Hi brendan,

          Yes, that’s what I’m suggesting. Cholesterol is important for immunity too, but it’s not necessarily something you want to eat in large quantities whenever blood lipids are low.

          Also, remember cholesterol is not the only thing in serum lipids. They have triglycerides, phospholipids, lipoproteins, and other compounds along with cholesterol. So you really want a fat-rich diet with diverse food sources, not cholesterol specifically, to increase serum lipids.

          I would agree that the fillers could be a problem. Just eat egg yolks.

          If you do have a genetic issue in lipid synthesis, then consuming more cholesterol (and other lipids) would be smart. On the other hand if the genetic defect is in lipid transport, it could be too much is being removed from the blood and you wouldn’t benefit from eating more. Perhaps you should get a gene profile from 23andme and see if it shows anything.

          But I think the infectious possibility deserves investigation, since you have had all of these symptoms which an infection might explain.

          • Hepatitis C (and possibly Hep G, though this seems to be benign) can be an occult infection and cause low cholesterol (as well as affecting mood). Probably not something you’ve obviously been exposed to, but maybe worth getting tested when you test for other pathogens.

          • Hey Paul and George,

            Yes, I agree that the infectious possibility is worth exploring and may in fact be the root cause of all of the problems I’ve had.

            It’s just extraordinarily difficult (and maybe impossible) to evaluate this possibility within the conventional medical system. I don’t even know where to begin. I saw an infectious disease specialist in my hometown a few months ago and he basically laughed at me, ordered some very basic blood tests and then lost the results.

            So I really, really hope that I can solve this problem without resorting to doctors again.

  6. Paul

    Bonebroth making cud b difficult for me right now. So i was thinking of gelatin supplement. My naturopath says they make it out of cow hooves n u dont want to eat it.
    Is there a safer choice of supplement?
    Paul What wud be ur suggested dose of iodine for a toddler?

    Thanks a million

    • I do make my own bone broth in the crock pot and it is super easy, just takes a while. The gelatin in the broth is amazing! When I don’t have good bones for broth, I use Great Lakes Kosher Gelatin flakes. They use only gelatin from grass-fed cows and not from hooves. That would not be kosher. It contains protein and minerals and can be added to hot liquids or cold. You can order it online through Amazon, of course.

    • Hi Koki,

      Ox hooves are a fine ingredient for soup making, and there’s nothing wrong with them as a source for gelatin.

      For a toddler I’d suggest cutting up seaweed and mixing that into food, plus feeding shellfish regularly. Seasoned seaweed snacks (see our recipe) are delicious – our recipe is here: http://perfecthealthdiet.com/2011/01/homemade-seasoned-seaweed/. You could also break up a 225 mcg tablet and give a ~50 mcg fragment once a day, but I think that amount can easily be obtained from food.

  7. I’d like to know the answer to that too.

  8. What is your take on insulin resistance and diabetes, and how they come to be? What factors are involved? Also, I heard that eating 5-6 small meals a day as opposed to 3 larger meals is not helpful when trying to avoid insulin resistance, due to insulin being elevated all day long and your body never having a chance to recover to a neutral state. What do you think?

    • Hi Mary,

      Our book discusses the factors generating insulin resistance and diabetes — there are many, but it boils down to energy overload with no good way to dispose of it.

      I agree, one should not eat many small meals. Intermittent fasting is a better strategy. It’s desirable to be in a fasted state at least part of each day.

      • So within that 8-10 hour window that one should eat, is it okay to have perhaps 2-3 medium sized meals and 1-2 snacks? I don’t function well if I haven’t eaten for 2.5-3 hours.

        • Hi Mary,


          Is your blood glucose well regulated during a fast? Do you monitor it?

          • I’m usually fine overnight and into the late morning unless I’m feeling a low in the morning (and then I won’t have a fast day). It is usually after a meal that I feel hypoglycemic symptoms even if my blood sugar is only a bit below normal. Right after a meal it never gets too high, especially now that I combine fat, protein and carbs. I think that because I am prone to anxiety I feel the effects of needing some fuel again sooner than others. Would it be a bad idea to say eat breakfast around 10 to 11 and then have a snack around 12:30 and then have my lunch around 3, dinner around 6-7. I find that I feel fine in the evening, but that tends to be when blood sugar raises naturally. Does it matter how much time is spaced between meals? Will that affect insulin in a bad way (keep it raised too much)? Maybe I need to eat more frequently because of the stress response if my blood sugar is dipping a little, but I wouldn’t know how to fix this without eating smaller meals at least every 3 hours. What do you recommend for reactive hypoglycemia? Chris Kresser wrote an article and said for people with maladaptive blood sugar regulation, it might be easier on the stress response to eat a little more frequently. Also I will get shakes at night sometimes if I don’t have a tiny bit of fructose usually a dab of honey (might be more effective at keeping liver glycogen even during night). My blood sugar is fine if I check it during the night. I don’t have diabetes, but it runs in my family. I did have one morning where I felt so hypoglycemic I almost didn’t make it to the fridge for a pop and it took all morning to get over that feeling. I think anxiety compounds the hypo feelings. They were a LOT worse on low carb. Thanks Paul for all of your insight.

          • I do think avoiding long fasts without carbs is a good idea if you have trouble controlling blood sugar levels. Poor control means you don’t respond properly to the hormones that arrange for stable blood glucose, which means you’ll be in more trouble when those hormones need to do more work, as after a long fast.

            How frequent your eating should be is something you should experiment with. But carbs before bed should help.

          • Paul one last question then. So you suggest that I avoid intermittent fasting altogether? I don’t seem to do to badly with the night fasts into late morning, but you think they’ll cause me trouble? I’m guessing your book will address hypoglycemia a little more and the hormones involved.

          • Hi Mary,

            Fast if you can, but be aware that you may have more difficulty than others carrying on a long fast, and if it gives you stress, fast a little less long than others would.

  9. Not a Q or an A, just some info:

    Here is a way to make adding egg yolks to your diet fun :mrgreen: you don’t need to understand the language


  10. Hi Paul,

    More yolk questions:
    – In Europe at least, pastured egg yolks are prone to high levels of dioxin, see http://orgprints.org/10175/ . When eating 3 yolks a day, does that mean that it’s better to each non-pastured eggs?
    – What do you think the yolk intake of infants should be? We have a baby that’s starting to eat solid food, would one yolk a day be too much?
    – Should yolks be cooked? What level of cooking eliminates infection vectors?
    – Is there a limit (aside from dioxin) to how much yolk one should eat?


    PS: LOL at the waterbottle gift 🙂

    • Hi Wout,

      Personally, I would eat the pastured egg yolks and not worry about the dioxin. It sounds like levels are small. A healthy liver should be able to detoxify it.

      Infant calorie intake is actually pretty high, like 1/3 adult intake, so one yolk a day should be good.

      I don’t think it’s necessary to cook yolks. There is an infection risk, but it is low, and mainly digestive tract pathogens like Salmonella.

      I don’t think there’s a strong limit on egg yolk consumption — ie negative effects would rise slowly, not sharply — and I would guess it would be driven by either omega-6 fats or vitamin A. Egg yolks have a pretty good mix of nutrients.

      • Yeah, I’ve just been eating pastured since I couldn’t find any clear information on the exact toxicity of dioxins either, it’s just that upping my intake by 3x made me want to think about that decision again 🙂

        As for the infection, I suppose it would be safer to cook the yolk for the baby then, seeing how her immune system is still immature… Do you know of any health benefits that raw yolk would have?

  11. When you guys eat steaks do you cut off any of the fat, or do you just eat it all?

    Also I seem to be consistently pretty low on my carbohydrates. I’ve got My Fitness Pal set to the 15-30-55 and 2k calories, so it gives me 150g of carbs every day.

    Generally I’ll eat ~1 lb of potatoes over the course of the day like your book suggests, but that’s only like 50g of carbs.

    I get a few more carbs from fruit and occasionally yogurt or ice cream but generally I average only ~100g.

    Should I be adding in more safe starches and fruit to get that up, or should I be eating more then 75g of protein to help compensate?


    • Hi Isaac,

      We eat the fat, but if we were on a weight loss diet we would trim it.

      I think 1 lb of potatoes is more like 125 g carbs.

      Is your appetite minimal? If you’re not hungry and a 16-hour overnight fast is comfortable then I’d say you’re probably getting enough carbs. Do eat that 1 lb of safe starch per day, though.

      • Could it be red potatoes vs. russet? I’ve generally been buying the bigger reds since they’re cheap and easy to get at the farmer’s market.

        Regardless yeah I’m pretty comfortable fasting so I won’t worry about it.


  12. Hi Paul,
    I have been diagnosed with leaky gut via an intestinal permeability test (mannitol and lactulose test).
    It has been recommended that I take 8 grams twice a day of L-Glutamine in an attempt to heal the gut lining.
    What is your opinion of L-Glutamine as a supplement? Should I consider it safe or simply focus on bone broths etc?
    Also, do you think it is possible to heal the gut with h.pylori present? Two courses of antibiotics plus attempts with botanicals and it is not going anywhere. I do seem to be able to control the symptoms with low fibre (carbs from white rice and dextrose).
    Thanks again,

    • Hi Adam,

      I’m not a fan of glutamine – I prefer regular food protein – but since you’re having so much trouble I guess it’s worth an experiment. Be aware that glutamine has a chance to make things worse, since it can feed gut bacteria, so do a careful experiment in which it’s the only thing you change.

      Personally I would focus on joint-rich broths (ox hooves, chicken feet, ox tail, or bones with lots of white joint matter) and take glutathione between meals, maybe butyrate if you can find it (pastured butter is a source).

      The H pylori is a problem. If the antibiotics and botanicals aren’t working then I don’t know what to do, but I would definitely research it and continue working on that one.

      • If glutamine potentially feeds gut bacteria, then isn’t it possible that meat/bone broths and gelatin would too? What is the recommended treatment if you have the sort of condition that feeds off of glutamine?

  13. Dear Paul,

    Each day is better than the previous one with PHD ! Thanks a lot ! One question about the diet. We try to follow in family your diet, and it’s a great deal ! 😉 Anyway, while my brother digest meat so well, I cannot digest it as easily, although a long time passed chewing. beef or lamb .. ^^ I ‘m feeling much better on fish and shellfish based meals. It seems my body is craving for salmon.. 🙄 Can I eat more than 1 pound /week of salmon or fatty fish regarding both a weight loss goal and the low omega 6 ratio required in the diet ? In this case,Do you recommend cutting olive oil or coconut oil to balance when eating more salmon ? or which reasonable quantity of added fat is recommended on a diet only made with PHD diet with white fish and 1pd salmon per week ? Thanks a lot, Best of all, Maya.

    • Hi Maya,

      If you crave it I would eat it, but probably that will only be a temporary effect. You can definitely eat fish every day, fish is terrific, but most days it should be a less oily fish than salmon. You don’t want to overdose on omega-3s, except as a temporary measure to replenish a deficiency.

      There are a lot of healthy fish that aren’t very fatty, so you can combine them with butter or other healthy oils and make a great meal.

      As for the amount of fat, follow your taste. Try to make your food as delicious as you can, but not oily.

      • Thanks Paul ! Anyway, what kind of damaging condition is involved with an overdose of omega 3, to prefer butter or healthy oils rather than a “huge” quantity of omega 3 (hidden in salmon or other fatty fish )?

        In the new supp recommended “red palm oil” is listed. I can only find palm oil (a big white block named “huile de palme” en français dans le texte..)I don’t know whether it’s kernel palm oil or whatever..? The amount of PUFA is 10 gr/100 gr of fat(?!). Is it the one you recommend, or would you suggest to avoid it ? Thanks Paul !Best,Maya

  14. Hi Paul,

    Seeing that you recommend a B-complex, which contains folic acid, I’m a little confused. We’ve been warned against taking folic acid, by you and others. Chris Kresser recommends only taking the 5-methyltetrahydrofolate form, if one feels it’s necessary to supplement. I understand that the amount of folic acid you recommend is quite small, given that it is only weekly, but since I take a relatively small dose of medication once a week that depletes my body entirely of folate for 24 hrs. (to control RA), I wonder if I should take a little more. I make sure I get the RDA of folate in foods every day, as well.

    • Hi Cathryn,

      Yes, I want to avoid folic acid supplements, but 400 mcg averaged over a week is 53 mcg/day which is safe. I wouldn’t take folic acid every day.

      The reason I say B-50 instead of taking B1/B2/B6 is to reduce the number of pills by a few. But it would be fine to replace the B-50 with B1/B2/B6 individual supplements.

      In your specific case, you may benefit from extra folate when you take the medicine. An active folate form such as Chris recommends would be good.

  15. Hi Paul,
    Can you direct me to the post or comment where you gave a brief recipe for a hydration electrolyte drink? I tried the search function a few times but I haven’t found it yet. I know the basic components, just not the amounts. Didn’t I read that on here somewhere?

    • I put that together for fun in a talk, but I think the best way is through food:
      – bone broth soup for calcium/phosphorus
      – tomatoes, potatoes, etc for potassium
      – a bit of salt on food for sodium and chlorine
      – supplemental magnesium, iodine, and lithium as recommended

      That should cover electrolytes well.

  16. Hi Paul! I know you’re busy but I have a quick question about the 16hr fast. I go to sleep fairly early, like 9:30. I take thyroid meds at bedtime so I need to have as much time since eating as I can. I get up early, 6:30. Can I do the 16/8hrs from 9am-5 eat, and then go from 5pm-9am? I don’t like to eat up until 8pm because of too much food before bed. How many days a week, a month, do you recommend for this practice?

    Can’t wait for the new book!


    • Hi Jan,

      Yes! That’s almost a perfect schedule. Very Paleo (eat in daytime hours, sleep in peak darkness, up at dawn).

      Do what is comfortable, but ideally it will become comfortable every day and be your normal routine.

  17. Hi Paul n PHDers

    I just read about a product from Prothera that they say heals GI tissues n protects them . Given below is the description . Do u think its promising or have u tried cats claw before?
    “AC-11®, the active ingredient in Protectagen™, is a patented, water-soluble botanical extract of Uncaria tomentosa (commonly called cat’s claw) that supports cellular resistance to a wide variety of environmental stressors and may be particularly beneficial to support gastrointestinal healing. AC-11® provides a rich source of phytochemical compounds called carboxyl alkyl esters that provide powerful antioxidant activity to minimize damage to delicate GI tissues. These carboxyl alkyl esters also have the unique ability to regulate inflammatory mechanisms while promoting DNA repair, which are key to promoting gastrointestinal healing and maintaining GI function. AC-11® extract is manufactured through a patented process and is standardized to contain 8-10% carboxyl alkyl esters. Unlike other preparations of Uncaria tomentosa, this unique water-soluble extract is also free of potentially immunosuppressive oxindole alkaloids (TOA’s). AC-11®’s unique content of carboxyl alkyl and other patent process esters unencumbered by the presence of indole alkaloids allows Protectagen™ to exert potent antioxidant activity and attenuate inflammatory responses while effectively promoting DNA repair and cell-mediated immunity. “

  18. “I take thyroid meds at bedtime so I need to have as much time since eating as I can.”

    It’s a myth that thyroid hormones (if that’s what you’re taking) must be taken away from food. The worst that will happen if you take them with food is that their absorption may be reduced, but as long as your diet is reasonably consistent that will only affect your dose requirements, not the benefits of the drugs.

    This is one of many myths believed and taught by almost every endocrinologist but lacking any evidentiary basis. Through experimentation with thousands of hypothyroid people on combined T4/T3 therapy, my endo has tested many of these beliefs and found them to be baseless.

    Of course you *can* take thyroid hormone on an empty stomach, but you don’t have to.

    It’s interesting to me that you take them at night. That’s unusual. Another endocrinology myth is that thyroid hormones should be taken in the morning. My endo has found that many people report much better sleep if they take their T4 at dinnertime. This conforms with known thyroid physiology, since T4 rises at night.

    • Interesting! My dr. preaches and it is plastered all over bottle to take 1 hour after meds? If this is true it sure will make my life a lot easier. What about interference of other supplements. She also warns me not to take calcium or magnesium within 4 hours……. Do you have any comments about that?

      • Arlenena, my endo has found that it’s the same with supplements as with food. Maybe they reduce absorption, maybe they don’t. It’s not clear. Some might even increase absorption; who knows? If you look for the evidence behind these kinds of drug administration recommendations you’ll be shocked how little there is.

        But it doesn’t really matter as long as your doc follows your labs and listens to how you feel (the latter is rather rare, unfortunately) and makes any needed dose adjustments.

        *Any* change in medication protocol can require dose adjustments. For example, I recently switched from Levoxyl to Tirosint, since my endo is always trying to use the cleanest drugs with the fewest excipients and other compounds that cause problems.

        Turns out the Tirosint, though a remarkably clean formulation, is significantly less bioavailable than the Levoxyl. So most patients, including me, require a little higher dose. No big deal, as long as you make sure your dose is adjusted appropriately if you feel lousy after changing your protocol.

        Your doc won’t be amused at these ideas. The orthodoxy around hypothyroid therapy is of a virtually religious nature, like so much else in medicine these days.

  19. Paul

    I bought a bottle of Garden of Life primal defense probiotics. Today I read something about the HSO in them that scared me . As i already duffer from parasitic infections .

    “To summarize the research briefly, soil organisms (SO) are spore formers, so they make make good competitors for yeast, fungus and other pathogens. This is why so many people taking soil organisms will initially experience very favorable results. However these spores are are extremely difficult to kill, surviving sterilants, disinfectants, acceleration forces, heat, pressure, radiation and many antibiotics. Strong antibiotics — like Vancomycin — can suppress certain spores. Spores are so persistent in the intestines that another round of germination may occur after the the drug is stopped. Soil organisms can also adapt loose genetic material and incorporate it into their cellular structure – the ramifications of which are yet unknown. Various soil organisms can also produce harmful peptides, affecting hemoglobin in the blood. It’s important to keep in mind that virtually all antibiotic drugs were were initially developed from soil organisms and as antibiotics become more potent, they cause more damage to the host, not just in the immediate gut environment, but systematically as well.

    • Interesting. Soil bacteria normally don’t flourish well in the body, but they can create acute infections. The warning seems to be saying that after gene exchange with gut bacteria they may be able to create persistent infections as well.

      When I update the supplements page I think I’ll remove the probiotics line and just recommend fermented foods.

  20. Hi Paul,

    I was the woman with heart palpitations and a fib in response to probiotics. I also have hashimotos. I followed your advice and got a metametrix stool test and started following your diet. The stool test showed I had H pylori which was treated with triple therapy and a follow up of a natural protocal of lauricidin and berberine (and xylitol and lactoferrin for the biofilm) It got rid of it. A recent stool test was negative for h pylori. However I still had heart arrythmia. The arrythmia seems to be autoimmune related because when I do things to help my immune system it reduces the arrythmia symptoms. The things that have helped have been a glutathion recycler, a glutathion cream, and nitric balance from apex energetics. I was doing the diet and the vitamin c and acetyl cysteine but it wasn’t enough. I’m attaching a link to Dr Kharrazian’s site on both of those topics. http://thyroidbook.com/blog/nitric-oxide-modulation-for-autoimmune-disease/ http://thyroidbook.com/blog/glutathione-recycling-for-autoimmune-disease/ I’m currently working with a DC that works closely with Datis Kharrazian. He’s ordered an array 4 and 5 panel from Cyrex labs. Here’s a link http://www.cyrexlabs.com/CyrexTestsArrays/tabid/136/Default.aspx
    The array 4 panel will show if there is something that my immune system is cross reacting to as it would to gluten. It tests 24 items including coffee, rice, and potato. The array 5 will show if I have other autoimmune anitbodies to other systems. I want to acknowledge all you know and your hard work and how graciously and generously you sharethis information; but respectfully, there’s a lot about autoimmune conditions you don’t know. Dr Kharrazian works with fragile autoimmune patients on a regular basis and for a number of years, he also reads the latest research and trains other health care providers. It would be great if you guys could team up and pool your knowledge.

    • Hi Cathy,

      Thanks for providing an update. I agree, there’s a lot I don’t know. Thanks for helping to educate me.

      Please let me know the results of the tests, and if they help resolve your problems.

      Best, Paul

    • Cathy, as you may know Dr. Guy Abraham’s iodine protocol has proven quite effective against afib, based on anecdotal reports from iodine doctors and patients.

      Dr. A. speculated that this would be case. He believed that amiodarone, a highly toxic, organic, iodine-containing drug commonly used for afib worked due to its release of high dose inorganic iodine. Its awful toxicity derives, in this view, from the organic molecule containing the iodine. Why not just supply the high dose inorganic iodine and skip the toxic drug delivering it?

      One of my own docs experienced relief from his afib, and was able to discontinue his amiodarone, by supplementing iodine.

      Just another option to consider, although be aware that the iodine protocol uses much higher doses of iodine (as well as selenium) than Paul recommends here.

  21. Real Food Eater

    Hey Paul,

    Stephan from Whole Health Source maintains (correct me if I am wrong) that a cause of obesity could potentially be from leptin resistance, which is caused by inflammation of the hypothalamus, which is created by eating highly engineered, addictive, processed foods (or even palatable foods). What is your understanding of leptin resistance?–do you believe that it is caused via highly palatable foods and subsequent inflammation of the hypothalamus? I remember you once stated that it is not the palatability of the food, but its lack of nutrients and inability to nourish the body. Also, do you know of any healthy cultures that ate fairly palatable foods?

    Sorry for the long set of questions,

    Real Food Eater

    • Hi RFE,

      Yes, obesity is caused by hypothalamic leptin resistance and hypothalamic inflammation. These can be brought about by eating an energy excess or by toxins or infections or endotoxemia or other factors. Insofar as junk foods lead people to have a cellular energy excess, then they contribute to obesity. The question is when, why, and how this happens.

      Healthy cultures eating palatable foods – French, Thai, Japanese.

      • george henderson

        In fact Japanese quisine, tempura at al., is very interesting from a “food reward” perspective.
        It is bland flavourless colourless food (fish, rice, chicken) made very palatable without herbs or spices, but mainly with seaweed and fermented grains and pulses (and, increasingly, MSG-type chemical additives not as popular in comparable chinese products).
        it is fundamentally unrewarding and unsatiating food made hyper-palatable by organically engineered flavourings, deep frying, etc.

        This paper has some interesting ideas about causes of obesity:

  22. Paul,

    I can’t find pastured eggs that are soy and grain free anywhere near me. Is eating grain/soy-fed organic egg yolks better than nothing, or is there a risk from the soy and omega-6?

    In terms of starchy carbs, should I include butternut squash, carrots, etc. as part of my 400 calories a day?

    • Hi Liz,

      It’s not perfect but it’s OK. Animals detoxify plant foods so eating soy and grain fed chickens is much better than eating soy or grains yourself.

      Butternut squash and carrots are great foods. Earlier we would have said 400 carb calories and don’t count them, now we’re saying more 600 carb calories and do count them.

  23. Dear Paul and Dear Sou-Ching, i was reading your precise and great comments to the China study. gratulation! my girlfriend and me have lately started with paleo and its wonderful to read additional comments to refine our way of nourishing, which also includes that we ordered your book-since your blog seems to us very balanced and not following dogmatic approaches.
    We have red Chris Kresser’s article on kefir and started experimenting with it and we love it- Since we were not so crazy about our home made goat kefir to avoid cow casein, we tried it now with fat (3,7) organic cow milk-this is very tasty, esp.after 36-48 hours with a kefir ferment. You are stating in the comments to the China study that dairy products of cow milk (probably with A1 casein) can be harmful to the body, if not predigested by some probiotic bacterias-so does it mean that if predigested like in homemade kefir it could be that most of the milk casein is broken down? just good to know if we drink it almost on daily bases…all the best and warm regards, Gregor

  24. Hi Paul,
    I’ve noticed that when I’m eating meat/proteins/butter (chicken, shrimps, eggs) I have a megahunger after, like i can’t stop myself. together with some “movements” on the right side gallblader/liver/duodenum. before I eat my gallblader is swallen, i have nausea, tirednes..

    I have also giardia diagnosed, pinworm candida and yersinia. I’m expecting Metametrix package to have the test and did like 2 parasites cleanse.
    I have a constant hunger felt in the right part somehow/gallbladder/liver….

    I thought it might be insulin resistance but how can I be sure? Are there any recommandations for diet antibacterial/antiparasites you thought might work better. I am on the paleo diet but from time to time I ate some bread or some pasta.

    Many thanks,

    • Hi David,

      The more different conditions and infections you have, usually the more it pays to eat a neutral diet that is in line with our food plate.

      I assume you’re in the care of a doctor who is helping you with these conditions.

  25. Hi Paul,
    Thank you for feedback – you’re probably right with the diet.
    As for the doctors – I’m still looking for a good naturopatic one abroad. Most of the findings were my efforts – my private money. Many of the doctors I’ve seen either were not interested to see/search more, scared (I can understand) either don’t know.They did not believe me for years that I have all these – send me to psichiatrist.

    Indeed I feel overwhelmed with all these but trust me here in my country they are not trained to see all the aspects just a slice and then stop.
    besides the situation of medical sistem is very poor – I live in Romania.

    I would be much gratefull if you or somebody else can have an ideea about that. E.g. for thyroid you told I’m subclinical Hypo and doctor told I’m ok..?

    I was in London last year spending a lot with 3 practitioner and seen other 2 conventional medicine(I’m jobless since 1 year) with small success.:(

    Many thanks for your care,

    • Hi David,

      It’s a difficult situation.

      Doctors often ignore subclinical hypothyroidism. The “normal” range is much too broad, and they assume you can’t be hypothyroid in that range.

      Thyroid hormone is fairly safe to try, so I would encourage a small experiment with that. I am not sure how best to treat the other infections.

  26. Paul,

    How much of an emphasis do you place on dietary variety when it comes to health? Do you typically eat the same thing day in and day out? …or do you switch it up every day? If you do switch it up, do you do so because you believe it is necessary for optimal health? What about eating say, the same breakfast every day, but switching it up in the afternoon and evening?

    Love your work BTW,


    • Hi Mike,

      I eat pretty similar things day to day, but they are nutrient rich. Meats are mostly fish/shellfish/beef/lamb, but organ meats add variety and different flavors of fish or shellfish and fattier cuts like rack of lamb. Egg yolks, coconut milk, rice vinegar, potatoes or rice, meat and vegetable routinely at lunch. Soups 3-5 days a week.

      Mostly I switch up ingredients, but the recipes are similar.

      • Thanks, Paul – And thank you for the tremendous free resource you provide us with this running Q+A. Hopefully you would allow me to ask one more quick completely unrelated question: After 6 very difficult years of progressive cognitive issues and unsuccessfully trying every natural diet, herb, and healing modality known to man, I suspect, thanks to the information you’ve provided on the topic, that I may have a C Pneumoniae brain infection. Immediately upon coming to this realization I ordered Metametrix organic acids and 2100 GI effects tests (through a popular website). Both test kits are in transit to my house as we speak and hopefully they will provide some useful diagnostic info. I do not see a naturopath regularly and haven’t seen a regular MD in over 10 years, however I have started to think that I need to dust off my insurance info and establish a relationship with a regular MD in order to get a prescription for Doxycycline. My question is this: If I were to go see a regular MD, is there a “regular” lab test that I could ask for in order to show a C. p infection and thereby justify the Doxycycline et al. prescriptions?

        P.S. If my situation turns out to truly be caused by a C.p infection, once it is fixed, words wont be able to express the gratitude I’d have.

        Many thanks for your time,


        • Hi Mike,

          The trouble with C pneumoniae is there’s no great way to diagnose it in clinical practice. They will look for antibodies but nearly everyone gets infected so the mere presence of antibodies doesn’t mean much. So they look at titer. But sometimes you can have a brain infection and the blood titer is low, or a blood infection and no brain infection. So it is unclear. A better test would be PCR for DNA in white blood cells. But antibody titers is what I think they would do.

          Best, Paul

      • I am also curious about this. Between FODMAPs, goiterogens, nightshades, and oxalates I am very confused about what vegetables to eat because I have a limited diet. Do you have nay recommendations for how to avoid these negative affects without completely limiting certain veggies?

        • Hi Elyse,

          Yes, since plants are the leading source of dietary toxins, variety among plant foods is much more important than variety among animal foods.

          For most people, just getting a variety of plants will keep toxin levels manageable.

          It may be desirable to check for sensitivities from time to time by eating a large amount of something you think might be a problem. If you are sensitive to it, then decrease the amount or eliminate for a while, then re-test a few months later.

          You can also eat fermented vegetables or take probiotics. Most of the sensitivities are a result of the particular gut flora you have, so altering the flora might help.

          • Thank you! Sorry to be so particular but I think the biggest group I eat is goiterogens as I have at least 1 cup almost every day on top of fermented food…would it be ok to just go one or two days a week without those veggies to help decrease chances of thyroid dysfunction? I still have a very difficult time pinpointing food sensitivities as the reaction seems very delayed, but I can say so far that the hives I receive are significantly worsened by garlic powder.

  27. Hi Paul,

    Can build up in the arteries/early heart disease be reversed with good diet changes? Is there any research evidence of this out there specifically about this?


  28. I clarification, what I am asking, is there good evidence to show that the build up can be stripped from the arteries and the damage caused reversed.



    • Martin, Dean Ornish has published books and peer-reviewed papers showing that his diet/regimen will do just that. However, it is a variant of the macrobiotic diet, which is (obviously) NOT paleo or “perfect.”

  29. Paul, I must have missed your recommendation for iodine supplementation. Is there a form/brand you think is the best?

  30. HI Paul,

    I’m really looking forward to the new book; have it on pre-order.

    RE: the recommend daily fasting. I find that I can do 12 hrs comfortably (7p-7a), then I eat three x 7a, 12:30noon, 6:30p. Any longer than the 12 hours and I feel like ripping off my shoe to chow down on while I prepare first meal!

    Brad Pilon writes that the benefits of fasting really start to kick in at 15 hrs, Berkhan and Sisson suggest 14 hrs only for us ladies. How important do you think it is for me to push the fasting? Curious: does Shou-Ching fast daily? Thanks!

    Kind regards,

    • Hi KKC,

      Yes, Shou-Ching does fast. She usually eats noon to 8 pm or so, might have a banana or egg at 11 am sometimes. However, it’s not a pure fast. She has a cup of coffee with cream at 7-8 am.

      I think if you’re hungry, you should eat. Not everyone can fast for long; especially those with adrenal/thyroid issues or some glycemic regulation disorders, or certain other problems.

      A few tricks you can try at the 12 hour point are taking a tablespoon of MCT oil – that may relieve hunger and enable you to go longer – or to exercise.

      But if the hunger does not go away so easily, I would definitely eat. In general you want to listen to your body and let it guide you. Don’t fast if you’re hungry. Rather, improve health and the ability to fast without hunger will increase.

  31. Paul
    We will be travelling back to India soon. I am planning to buy some supplements before We travel. Is it ok to go for a multivitamin like Megafoods instead of a different supplement for each vitamin or mineral? Or do u think the dosages would not be appropriate?

    Appreciate your guidance

    • Hi Koki,

      What you should supplement depends in part on what you plant to eat. The less nourishing your food the more a multivitamin makes sense.

      I would still take it maybe every other day instead of every day however.

      • Paul

        we generally eat quite healthy but I am anticipating troubles in continuing that for next 2 months due to our move back to India. The packing selling n stuff. I was trying to buy supplements based on your new recommendations.
        Thats when I was wondering if I should buy the individual supplements as your recs or go for multivitamin ?
        Especially for my kids 4 n 1 year olds

        • Hi Koki,

          I’d probably still stick with our new recommendations and try to eat the best food you can. I might add choline and copper if you can’t get liver/eggs, and selenium once or twice a week if you can’t get shellfish/seafood.

  32. I have just switched to a mostly ketogenic diet for reasons too involved to get into now. But one thing that puzzles me is that now immediately after I eat some coconut oil or other saturated fat at mealtime or snack, I feel like I just had a strong cup of coffee: my body gets really warm and I feel really stimulated, almost anxious. the feeling lasts for about an hour or two and then I feel great and don’t have to eat for hours. Any ideas?

  33. Chris, it’s called peroxisomal oxidation: some of the fat is converted straight to heat. Which prevents the energy being stored; ketones are also being exported from the liver, so your brain has more fuel.

    I’ve just made some interesting discoveries about selenium, viruses, cancer, and cholesterol.
    Who knew that they were connected in this way?

    • George,
      Thanks for the reply! I will have to check out the link you posted.
      Can I assume that the reaction from the fat is directly proportional to the amount consumed? Meaning, I will get less anxious/jittery if I eat a bit less coconut oil? Or is it more complex than that.

      • George Henderson

        If it’s an overflow pathway, it ought to be dose sensitive. It might also take time for the thyroid to adjust to the thermogenesis. It could be that you will notice it less in time. But I would think it is dose-sensitive. I usually try not to eat more than about 60g fat in a meal because otherwise my body doesn’t know what to do with it.

  34. Hi Paul, I had asked you several weeks ago about my ferritin levels that were low. I recently went for blood work to see if anything had changed. My iron and TIBC levels were
    IRON 160 28 – 170 ug/dL
    TOTAL IRON BIND CAP 301 240 – 405 ug/dL
    UIBC 141
    IRON SATURATION 53.0 13.0 – 53.0 %

    and ferritin was
    FERRITIN 10.4ng/ml where the normal range is 11.0 – 306.8 ng/mL

    I don’t understand the difference between ferritin and iron but i wonder if I am getting a lot of iron through supplements and more than enough healthy food what may be causing this. 6 weeks of iron supplement hasn’t improved matters much…any thoughts?

    • Hi Lauren,

      Ferritin is a storage protein which tries to lock iron away from pathogens or prevent free iron levels from rising too high.

      Do you have anemia, low hemoglobin or low red blood cell count?

      Low ferritin and high iron saturation is not a common diagnostic pattern (see table in http://en.wikipedia.org/wiki/Iron_tests) but some people do get it. I haven’t studied the topic but some of the important factors to keep in mind:

      – Iron is one of the most critical nutrients needed by infectious pathogens and so (a) during infections you’ll tend to have low iron + high ferritin as the immune system tries to lock iron away, but (b) some pathogens have learned how to get iron out of ferritin so infections with these tend to induce low iron;

      – Many people have variants in some of the genes for iron handling – these variants were probably selected to enhance immunity against diseases like malaria – the mutations commonly lead to a condition called hemochromatosis which most often produces high iron levels. Some people on hemochromatosis forums report having low ferritin and high iron saturation.

      I am not personally knowledgeable about what this pattern means or what to do about it. Chris Kresser has been studying up on the topic and might have some insight; a doctor who specializes in iron disorders should know some possibilities.

      • Hi Paul,

        Thanks for your insight. I don’t believe I have anemia, I thought that was dictated by the actual iron levels and not ferritin. As for hemoglobin, my level was 13.0 where 11.7 to 15.3 is within the normal range. My red blood cell count was 4/10 with 3.80 to 5.20 being the normal range (sorry if you know this). I did have a glucose level of 60 where 74-118 is normal range. They didn’t say anythign about this, but I was just looking for any other numbers being below normal limits.

        When you mentioned hemochromatosis, are you suggesting this could be something that may afflict me? I will certainly look more into it and I will also check out chris kesser.

        Historically, I have always had lower iron levels. When I had my kids, when I was kid and most of my adult life. I attributed it to ulcerative colitis…

  35. @ Lauren
    Ferritin is stored iron and changes in intake may only influence ferritin levels many months later. Red blood cell counts, haemoglobin, transferrin, and the counts you’ve provided are probably good indicators of current status.

    • They told me to come back in 6 months. I often have this problem though and would like to know what causes it. I have never taken a supplement long term for it but sounds like I need to give it some time.

  36. “A follow-up blood test is essential to demonstrate whether the treatment has been effective; it can be undertaken after two to four weeks. With oral iron, this usually requires a delay of three months for tablets to have a significant effect.”
    Retinol is an important factor for preventing anaemia in women.

  37. Hi Lauren,
    I am no expert on this blog, for sure, but when someone speaks of anemia, I feel like sharing. I am past menopause, so should not have to worry about iron deficiency, but, indeed, I do. In fact, whenever I have blood work done, if I am not taking some form of natural iron (18 mg max), my tests show that I am borderline anemic. These tests also show that I am not getting enough B12, even though I use a sublingual supplement. I eat beef and eggs almost daily, except for salmon days. I am still trying to figure out how to eat liver. In addition, many years ago I was given a stomach acid test and found that I produce little to none. So, I started supplementing HCl — doc’s orders.

    Now that my Metametrix stool profile has shown the presence of H. Pylori, I have been doing research and have found several references to H. Pylori creating low iron, low B12, and low stomach acid. So, has that been my issue all these years??? Just don’t know.

    It was a nationally known preventive medicine/integrative physician who found I had no stomach acid and a naturopath, general practice folks, and the nationally known guy who told me I needed iron and B12. No one suggested I get tested for pathogens that may be at the root of the problems with iron, B12, and HCl. I was told to take supplements. It took an astrophysicist on a personal mission to tip me off to the pathogen possibility. In addition, I had to request and pay for the lab test that returned results that surely justify the test. My monthly insurance premium is in the neighborhood of $700.

    But, still I’m thankful for Paul and Shou-Ching, for WAPF, and so thankful that I have the money to pay for my own lab work.

    Peace 🙂

    • If you ate liver, you’d be getting retinol and copper, the two iron co-factors, as well as B12 and folate with the iron.
      Carotenoids such as astaxanthin have a reputation for suppressing H. Pylori. Naturally sourced carotenoids such as dunalia salina, astaxanthin, or even spirulina (also high in iron, with some K2) are worth trying.
      In paleo circles we underestimate these natural carotenoids; sure, they’re not retinol, and they’re probably better for you if retinol is already adequate, but they can be very good for immunity, sun protection, and anti-inflammatory and anticancer (as long as they’re in natural ratios).

    • thanks for your insight lana

  38. Hi Paul, I’m hoping you can clarify this for me. I’m only 5′ tall and petite, so I put on weight easily if I eat more than 1300-1600 calories a day depending on exercise. If I’m supposed to eat 300 calories from protein and 600 from carbs, that only leaves me with 400-700 fat calories. I know this is less than you recommend. Is it enough to be healthy? Should I eat less protein or carbs to allow for more fat? 

    • Hi Nikki,

      As a small person you’ll have slightly reduced carb and protein needs. It might be that 250 calories protein, 500 calories carb, 700 calories fat would be a good 1450 calorie diet for you, something in that vicinity.

      It is possible to be well-nourished on only 500 calories fat but you have to be careful to eat nutrient-rich fat sources like egg yolks and organ meats and shellfish/marine fish. With 700 fat calories you get a bit more leeway to use oils.

      But as long as you are eating nourishing fats, a 600 carb – 300 protein – 500 fat calorie diet should be healthy. So if your taste preference runs that way, I wouldn’t worry about it.

  39. Dear Paul, in your book you give the recommendation to sleep in a complete dark room-very understandable in the city.
    but does the statement that any light is blocking melatonin production also apply to moon and star light as in normal natural conditions? this is questioning to me , since i believe humans and other mammals are not always opposed to complete darkness in nature surrounding. thanks, Gregor

    • Hi Gregor,

      Exactly how low light levels need to be to disturb sleep is not entirely clear. It’s been established that even a single momentary pulse of bright light will disrupt sleep, and that blue light is much more effective than red light at disturbing sleep, so George’s suggestion below to expose yourself to red light at night is an excellent one. If the night lights are natural (and therefore fairly reddish since blue moonlight/starlight is scattered) then they can still disturb sleep if bright enough, but there may be personal variations in how bright they need to be to disturb your sleep.

      The thing I like about letting natural light in is that the sunrise will wake you naturally. So perhaps totally opaque drapes aren’t desirable if you can arrange your sleep schedule to get up around dawn. But I think they should be dark enough to minimize transient headlights or similar disturbances.

  40. I’ve wondered about this too. But moonlight and possibly starlight are times of danger from predators and – especially – other humans, so we should be more alert. Firelight – flickering embers – I’m more inclined to think could be soothing for some.
    If someone insists on a nightlight I’d try a soft red one first, like a darkroom light. Oh that’s right, no-one uses darkrooms anymore.

  41. Paul, wondering what you think about the leptin reset protocol put forward by dr. Kruse. He recommends eating lots if protein and calories right when you get up. What is your take in leptin and diet/health?

    Second question, I have normal serum iron but a high ferritin level. I do have Hashis and am on meds, of course. I also take 1.5 mg LDN. Does a slightly high ferritin indicate infection/bacteria? Should I just donate blood or start looking for another cause?


    • Hi Jan,

      I don’t support that.

      High ferritin could indicate infection, or maybe immune activation by LPS from gut bacteria. It can also indicate iron overload, which is very common in people who have one of the many gene variants that give rise to hemochromatosis. Certain anemias can produce high ferritin, as can thalassemia and porphyria.

      The best thing to do is have a doctor do a full iron panel and blood cell count and see if it is iron overload or some other condition.

      Best, Paul

      • In autoimmunity interferon-gamma downregulates erythropoesis (red blood cell manufacture) and promotes iron going into ferritin.
        Glucosamine inhibits interferon-gamma production. I’m curious as to what it might do in this situation. Glucosamine also moderates the immune response to LPS, for example: http://www.ncbi.nlm.nih.gov/pubmed/16445576
        Ferritin production is also regulated by insulin.

        • Thanks George. I read the link on glucosamine. Interesting. Do you think it would help to take it? I do drink gelatin bone broth that I make which could help. My test for ferritin was in April and I had 173. The top range was 150. Of course, my dr said don’t worry about it, not really too high.

          What do you think about sulphur based supps like MSM or NAC?

          • I don’t know. I do think it’s a good alternative to NSAID painkillers, I used it when I had lots of teeth out and needed very little in the way of NSAIDs.
            Taking calcium carbonate with meals can reduce iron absorption; but anything relating to ferritin is a long-term project, results are seen after months.

            I never got much from MSM, NAC was good for some things. I think sulfur from protein and veges is conserved on a lower-carb diet; at least, I can taste it sometimes.

  42. What is LPS? If the high ferritin were caused by infection, would the ketogenic PHD help? I will get the full blood work done. Thanks.

    • LPS is lipopolysaccharide – cell wall components of gut bacteria that are carried into the body with food or through a leaky gut.

      The ketogenic diet could help or hurt depending on the infection, but if you don’t know the pathogen, it’s more likely to hurt than help. Our regular diet is the safest if you don’t know specifically what’s wrong.

  43. Just wondering if you are familiar with a new (?–at least new to me) diet called Forks over Knives (forksoverknives.com). Some friends recently made me aware of it and are convinced of its validity. It is VERY different from PHD, and I would love to hear your comment about it if you have time to look it over. Thank you!

  44. Hi Paul,

    This may have been asked here before but couldn’t find it in the search. What is your take on the connection between red meat and cancer, specifically breast cancer? Such as noted in this article: http://m.hopkinsmedicine.org/gim/_pdf/Jan2007.pdf



    • Hi Lindsay,

      There does seem to be an association so I usually suggest that cancer patients get protein from fish and shellfish. However, I don’t think the evidence is so strong that healthy people should avoid red meat out of concern for occult cancers.

      Possible candidates for a pro-cancer effect seem to be either sialic acid sugars on beef that benefit cancer cells, toxins generated in high-heat cooking (eg grilling) such as HCAs, and adding heme iron to people with iron overload (a common disorder). The last two possibilities are discussed in the paper you linked.

      The iron problem can be avoided by blood donation, and the toxin generation can be avoided by using gentle cooking. The sugars only matter after cancers are well evolved, they don’t initiate cancer in healthy people. So overall, I think PHD-style beef eating is safe, but some caution is warranted among cancer patients.

      Best, Paul

  45. Thanks for the fast reply, Paul. Do you also get a sense that red meat has an effect on estrogen receptive cancers because people are generally eating standard meat and that this would not be the same for grass fed beef? Also, do you define cancer patients as those with current cancers or also those in remission?

    Thanks again.

  46. Hi Paul, Sorry for reposting this, but I replied to you in the comments above, but it was posted so long ago I’m not sure that it shows up as a new message so I am pasting it again below. Here’s what I wrote pasted below. As always, thanks for your support and advice on my path towards a healthy body.
    Hi Paul,
    Thanks for your insight. I don’t believe I have anemia, I thought that was dictated by the actual iron levels and not ferritin. As for hemoglobin, my level was 13.0 where 11.7 to 15.3 is within the normal range. My red blood cell count was 4/10 with 3.80 to 5.20 being the normal range (sorry if you know this). I did have a glucose level of 60 where 74-118 is normal range. They didn’t say anythign about this, but I was just looking for any other numbers being below normal limits.
    When you mentioned hemochromatosis, are you suggesting this could be something that may afflict me? I will certainly look more into it and I will also check out chris kesser.
    Historically, I have always had lower iron levels. When I had my kids, when I was kid and most of my adult life. I attributed it to ulcerative colitis…Is it possible there just hasn’t been enough time for my body to absorb the iron. Maybe slow Fe would be better?

    • Hi Lauren,

      We’re getting a bit beyond my expertise, I’m not sure how to diagnose or treat specific cases with a mix of issues, eg how ulcerative colitis might interact with your conditions to produce that iron pattern. (UC often produces anemia, http://www.ncbi.nlm.nih.gov/pubmed/21122574, but I don’t know if the low ferritin – high iron saturation is typical.) Perhaps your doctors would be better able to answer those questions.

      • I’m sorry Paul, I understand. I will keep working on this and check with my doctor. Thank you! Enjoy the rest of your holiday weekend

  47. Hi Paul

    I wrote to you a while back about a back problem, which seems to be only muscular, not structural. The problem is widespread over my back and neck. The doctor seems to think it is fibromyalgia. Is fibromyalgia bacterial or viral in origin? Might lithium help for this and if so what form of lithium – carbonate or orotate? I suppose I would need a prescription for this?

    With thanks

    • Hi Lindsay,

      Fibromyalgia is probably multiple conditions, but sometimes it responds to antibiotics. Most of this case have had whole-body symptoms, or symptoms in joints, not localized to the back and neck. But you never know.

      I think low-dose lithium is good to try. Make sure the doses are low. Orotate is better. Up to 5 mg. No, no prescription, get it Amazon. Make sure you get 5 mg, they also sell 120 mg which is too much.

  48. any thoughts on Omega 3 enriched eggs?

  49. Hi Paul –
    Any time I eat a good amount of dairy (milk, greek yogurt, whey protein) I develop cystic acne. Is this the result of deficiency or am I just intolerant? I had read this could be due to a Vitamin A deficiency but I eat plenty of pastured eggs and (typically) liver weekly. Any thoughts on what I could do to help mitigate the acne?

  50. My husband has Hepatitis C and mitochondrial toxicity from the treatment for it (interferon/ribaviron). I did paleo, but his liver enzymes went up from going crazy with the fat. So I switched to primarily Omega 3s and no more bacon/fatty cuts of meat etc. and they came back down. Do you know the effects of the PHD on the liver and Hepatitis C? Thanks.

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