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. Paul,

    I have a friend that is vegan. He has had excellent results to date both personally and with his family.

    Saturated fats under 4.5 per serving no more.

    Nuts- strict moderation.

    As far as omega 3s he gets them through leafy greens and 2 table spoons of flaxseed on his cereal a day.

    He supplements vitamin B 12. 1000 mcg a day. His understanding is that your body only needs 3 mcg. But he enjoys more. As far viamiin D. He runs with his shirt off every other day running for at least 30 min in the sunshine. The rest comes from plants.

    Tons fruit seems to spike his LDL . So he does 3:1 ratio. 3 veggies one serving of fruit.

    He mainly follows the Caldwell Esselstyn diet.

    Would you have any concerns and/or recommendations?

    • I would first be concerned about lipid deficiencies. If his serum cholesterol is below 200 mg/dl, he should eat more fats.

      I would also worry about nutrients like choline. I won’t try to analyze a vegan diet for micronutrients, but I would suspect he is choline deficient.

      • Here’s a USDA pdf for choline content of common foods: http://www.nal.usda.gov/fnic/foodcomp/Data/Choline/Choline.pdf
        Note that betaine and folate can support choline, especially as he’s supplementing B12. Beetroot and spinach are high in betaine (also bran and wheatgerm, but let’s not go there). Dietary methionine is another factor.

      • My friends father suffered from a heart attack at age 59 and his lipid levels were 190. He believes heart disease to be a food born illness. Genetics play a contributing factor but he feels food trumps genetics (97% of the time). Increase fat intack sounds insane to him. Please advise.

        • Hi SC,

          He’s not wrong about food being the main factor in heart attacks (lifestyle also) – just wrong about which foods cause the problem.

          Perhaps he should read our book?

          • Agreed, info on sat fat to detailed for a post reply. I would have referenced the specific PHD material on saturated fat but just gave my last copy of PHD to another friend and hanging on until the new edition comes out.

  2. Hey Paul

    I love PHD. It makes me feel great, I am always satisfied at the end of a meal. I don’t have to eat as much anymore because I don’t have cravings.
    The problem is that I was not overweight in the slightest when I started the diet. I was about 20% body fat. Since starting PHD, I’ve lost weight, and now I’ve stopped menstruating. Of course, I’d say my digestive issues take part of the blame. I don’t often feel hungry anyway.
    Any ideas for healthy weight gain on the PHD diet?
    I love fruit. Do you think that baking fruit, like apples, makes it unhealthy? I know I have to be cautious because I struggle with candida, but seriously, I need to put on a few pounds.
    I know at one point you were very underweight. What did you do? Thanks so much for all your replies! Your work is such a blessing 🙂

    Nora S

    • Hi Nora,

      Well, stopping menstruating is no good. Have you gone too low carb? Or too low protein?

      A pound a day of fruit is fine. You can bake it.

      My underweight was due to scurvy, the weight came back as soon as I supplemented vitamin C.

      • Hi Paul and Nora,

        I also struggle with secondary amenorrhea (exactly 365 days with no mensus). Yesterday the doctor told me he is “baffled” by me. This is the third MD I have puzzled. I have also seen a naturopath who did not know how to help me either. I have had progesterone, estradiol, testosterone, t3 and t4, fsh, lh levels checked multiple times and each time all of them are low and don’t really change. The doctor put me on 60mg of Armour/day as well as bio-identical testosterone 20mg cream and although my hypothyroid symptoms have subsided and free t3 raised to 3.5, I still have low estrogen, progesterone and testosterone, and no mensus. I am only 24 years old and very healthy otherwise. I feel good and sleep well and the only symptoms I currently have are low libido and no mensus. I exercise at a low-moderate intensity level almost daily. I have no stress in my life. Also I have been gluten free for over a year.

        DR wants to start me on bio-identical HRT… progesterone 100 mg days 1-21 and estrogen 1 mg every morning. He said I need the estrogen to protect my bones. I am fine with the progesterone but I wonder if having low estrogen is such a bad thing? I read a lot about the dangers of estrogen supplementation. I have low HDL (45) and LDL is also very low and I know cholesterol is needed to make pregnenolone which his the building block of hormones … but when I asked my DR about this he said my DHEA is fine (180) which is a precursor to the other steroid hormones so he didn’t think low cholesterol was the cause. Hence the “baffling”. He thought it was premature ovarian failure but since my fsh is low this isn’t indicative.

        I have followed the PHD for about a month and feel great on it. Also I have ordered all of the supplements and can’t wait for them to get here! I just don’t know if I should start this BHRT or if I should first give the PHD longer and see if it helps to raise all of my hormone levels.

  3. Hi Paul and others,

    Have you ever heard of Type 1 diabetics being able to either reduce or eliminate insulin injections after supplementing with (high dose?) Iodine? I just came across this article from Jorge Flechas. Is that a reputable source?


    Sounds really great, who knows.


  4. “…iodine supports immune function and many of these disease may have infectious components.”

    Perhaps a possible explanation, but this is not to my knowledge how Dr. Flechas has interpreted his clinical observations. I think his view is that iodine is essential for the functioning of hormone receptors quite generally, so repleting it with Dr. Abraham’s iodine protocol can improve the functioning of a variety of hormone systems.

    Diabetes is just one example, with diabetics able to reduce or eliminate insulin supplementation.

    Hypothyroidism (thyroid hormones) is another, with people (like me) able to reduce or eliminate thyroid hormone supplementation.

    Dr. F. has also reported patients who have been able to reduce or eliminate sex hormone supplements with the iodine protocol.

    It’s all quite remarkable, and just one of many benefits observed in the Iodine Project.

    • Just from the difference I see in my dog after adding kelp to her food, I actually credit this.
      A lot of things could be attributable to sub-clinical iodine deficiency. Thyroid cross-talks with many other systems; including estrogen, LDL, serotonin. If you lack the essential nutrient you need to regulate metabolism in the normal way, the body will compensate by altering other systems; or, even worse, it won’t.

      • Thanks everyone for your replies!

        So many questions, I don’t know where to start!

        Paul and Mario, do you guys have any plans to do another post relating to Iodine, like the hypothyroid ones on this site? I know you already have a long to do list of topics to cover, but just thought I’d plant the idea.

        Bill, about the iodine helping hormone receptors– if that was actually what was improving, then wouldn’t the thyroid hormones you had to take not have worked well if the thyroid hormone receptors weren’t functioning correctly/ sufficiently until you started the iodine? Or is it that you had to take so much thyroid hormone because the receptors weren’t working well, then after adding iodine, the receptors’ function improved, so you needed less and less replacement thyroid hormone?
        I’m thinking in terms of insulin (hormone)… since my insulin dose has remained pretty steady over the years, I assume my insulin hormone receptors are working fine, but who knows. I’ve actually been taking just a tad less insulin than I used to… I don’t know if that’s due to diet change (yay PHD!) or some physical changes (like insulin hormone receptors functioning better?) or both?

        Paul, I still haven’t started any iodine except for the multivitamin I used to take (shaklee) which had 150mcg iodine. But i dont take that anymore. At the moment, I’m only getting iodine from however much is in my food (including dulse flakes 1x/wk). I’m thinking of getting the Now brand Potassium with Iodine and start there. Then after a month, could I take twice the dose, or would that be too much potassium (I haven’t looked at the bottle yet)? Whatever I end up going with, does it need to have iodine and iodide or just one?

        Now switching the subject…

        Mario, Bill, George– you all commented before about your pets with regard to thyroid issues. I posted last week about my cat who’s hyperthyroid. Unfortunately I haven’t found a homeopathic vet near me to try alternative therapies. I’m taking her to vet today to look into methimazol (blocks thyroid hormone production). I don’t want to do it because I’m worried about it affecting other organs and just creating another problem, but she’s so thin and recently starting throwing up again so I don’t thinking have a choice now. Any thoughts or experiences with methimazol?

        • KH,

          The theory about hormone receptors seems plausible. Probably this is the case with all those hypothyroid patients declaring not felling well until taking large doses of thyroid hormones to have unnormal levels of free T3 and free T4.

          Regarding your cat. I would try methimazol, at least temporarily, to stabilize your cat and then focus on the probable cause of her hyperthyroidism: brominism. Things that are know to increase bromine excretation: iodine, selenium and sodium. Since we know that iodine can cause problems in cats, if they have autonomous thyroid nodules, you can try to give the minimal recommended dose of iodine and selenium for your cat and then focus on sodium. A saline solution plus diuretics increase bromide excretation even more (hemodyalisis too, but I don’t know if you can get that for your cat…). See here:


          My best wishes to your cat!

  5. H. Pylori
    I went to the Metametrix site and sent an inquiry. One question was about the “7.2E” notation, having never seen that before. Here is the reply. My present question is, what does “normal” background amount mean? That there are 100,000 of these organisms per gram of feces in most of us?

    “For H. pylori, a finding of 7.2 X 10? is 7.2 times the “normal” background amount found in stool specimens. Most bacteria reproduce quickly into very high numbers, so expressing their population growth in exponential notation is required for practical purposes. The finding is elevated, but not all elevations of stool H. pylori are accompanied by classic symptoms of gastric irritation, GERD, nausea, etc. However, the Thorne product is helpful in cutting back those numbers of H. pylori, (with less harm than antibiotic therapy can cause) so it theoretically can help resolve any symptom caused by the bug if it lowers the numbers of the organism. It may be helpful to follow up this test with a stool H. pylori antigen test.

    There are no data comparing stool H. pylori with stomach symptoms in a large population. This would be helpful information. Many people do carry elevated stool H. pylori who remain asymptomatic, with negative antigen tests as well. It is wise to monitor yearly at least.”

  6. Hi Paul,

    I’ve noticed that my migraines amplify in the sleepy times of the night and waking part of the mornings and then fade down a bit during the day, what could this mean? Also, when eating carbs throughout the day, before I started perfect-keto to aid me against the migraines, it would fade down significantly — but never solve the problem.

    I also just figured out that when I told you about the time I drank lots of coconut milk, which resulted in one of my “clear day”, I have managed to partially repeat this, except this time it was different. I still had the migraine, albeit it being veryyy soft, but my energy levels in the morning — just like on my clear day — was amazing and I felt unusually happy in the morning. On my accidental clear day, I ate 4 hard boiled eggs, a small, bowl of carrot and swede mash and big glass of coconut milk. This time I simply ate 4 eggs scrambled with 1 tablespoon of palm kernel oil and 1/4 cup of cooked rice. I should note that on the accidental clear day I was fasting 20/4 because of Ramadan, and on my other day — I ate low calorie vegetables sauteed in Palm Kernel Oil because I had run out of Coconut Oil to spoon from. But the two situations have this similarity — I ate those meals and slept (surprisingly quick) within 10-20 minutes after finishing those meals. They both ended up being a healthy 8 hour sleep with great dreams — and I woke up with no alarm clock required. I was also wondering if the lysine/leucine from the eggs had anything to do with this. Or maybe high fat meals just when I’m reaching sleepyness help create a good sleep. I have no idea if this relates to my migraines or not tbh, which is why I’d love your input.


  7. Hi Faisal,

    I don’t know, you’ll have to keep experimenting. One thing I would try is intermittent fasting with a bit more carbs during the feeding window — finish the fast eating coconut oil & palm kernel oil for a last few hours of ketosis, then have your meals with carbs and protein. I don’t know if this will help but it may clarify what it is that is helping you.

    • Thanks for you reply.

      I’ll try upping my carbs and protein for lunch, and make both breakfast and dinner dominantly high-fat and see if that helps.

  8. Hi Paul,

    Do you have any recommendations for the “skinny” type of PCOS? My girlfriend is small (5’2″ and 113 lbs). She also seems to have no blood sugar problems, either fasting or after meals, so the common advice to lose weight and/or improve insulin sensitivity isn’t applicable.

    To date, doctors have been stumped as to helping her regain normal hormonal levels and normal ovulation/menstruation. In the past she has tried various medicinal treatments unsuccessfully, including: metformin and various gonadatropins.

    Her condition has progressed to the point that her right ovary grew to nearly 2x normal size and that resulted in emergency surgery for ovarian torsion this summer. Just a week later, she needed a follow-up surgery to stitch the ovary to a ligament for purposes of preventing future torsion.

    Any advice, dietary or otherwise?



    • Hi Kevin,

      Is she on our diet and supplements? That’s our dietary advice.

    • You should put her on PHD diet and look for iodine supplementation. From Dr. Flechas:


      “Iodine deficiency may cause the ovaries to develop cysts, nodules and scar tissue. At its worse this ovarian pathology is very similar to that of polycystic ovarian syndrome (PCOS). As of the writing of this article I have five PCOS patients. The patients have successfully been brought under control with the use of 50 mg of iodine per day. Control with these patients meaning cysts are gone, periods every 28 days and type 2 diabetes mellitus under control.”

      • Thanks for the prompt response guys. She has been on PHD diet and supplements for about two weeks now. Included in that is a daily supplement of 225 mcg iodine. Our plan is to stay at this low dose for a month or two before doubling, and then try doubling every month or two thereafter up to a certain point, ie the recommendations in the book. Still think that’s a solid plan, or would you recommend upping the dosage quicker than that? Not sure if its relevant, but a basic blood panel a while ago showed a slightly abnormal thyroid result. But a follow-up test was back to normal range.

        Thanks again,


        • Hi Kevin,

          I think that’s a prudent plan. Since there’s reason to think she’s had thyroid issues I wouldn’t make sudden changes. She should carefully monitor how she responds to changes of iodine dose. The best response is to not notice anything.

          • Thanks again!

            We will keep on with the PHD diet and supplements and let you know after a while what, if any, impact that has on her condition. You guys are great!

  9. I finally got around to having the Metametrix GI Effects test and my results show H. Pylori and pinworms. My chiropractor, who ordered the test at my request, is recommending I take BioRay’s Detox Trio, which he conveniently sells. If anyone else has had either result I’d love to know what course of action you took and your results? I’d love to go the natural route but I’m not opposed to taking conventional meds.

    My test also showed that some of my good bacteria was on the lowside, even after eating fermented veggies on a daily basis and drinking kefir a few times a week. I’m thinking of trying probiotics for a bit. I’ve heard good things about Bio-cult – any others I should look into?

    Not sure if it’s relevant, but I took the test in an attempt to figure out what’s causing my cystic acne (abruptly started in February) and occasional constipation. I take all the supplements and follow the diet, so it’s a bit of a mystery.

    • Hi Ashley,

      Maybe the acne and constipation was caused by the pinworm infection. I don’t know what the best way to treat that is, I leave that sort of thing to doctors. Probiotics are worth a try but probably aren’t any better than fermented veggies and aren’t a substitute for specifically treating the infection.

      Pinworm infection is spread by contact with fecal matter, so maybe someone didn’t wash their hands. Probably just bad luck.

    • Hi Ashley,
      I too recently received my Metametrix GI Function Profile and it showed a high concentration of H. Pylori. (See my previous posts) Since I do not exhibit any of the primary symptoms — gastritis, reflux, etc., my doc put me on Thorne SF734, 2 caps 4x a day for two months, along with Thorne Bio-Gest, and Thera-Complete Powder. I have not started the Thera because I have an ample supply of Bio-Kult at the moment. It contains Bacillis Subtillis, which is supposed to be quite effective at taking on H.Pylori (source – the web – so?)

      It’s been two and a half weeks, so don’t know much yet. After the first three days my formerly intensely itching eyes no longer itch. Haven’t had a single episode. Then, last night I was tired from a long day at work and my body felt as if I should have the familiar high back pain that comes on when I’m tired. But no back pain. Don’t know. I need more time. Some on the net say that a back pain can accompany H.Pylori.

      Read Amy King’s story at: http://amyking.wordpress.com/2009/02/20/im-so-happy-i-have-h-pylori/
      I do not like what I have read about the antibiotic treatment, so will save that for later, after I’ve finished SF734. Sean Croxton recommends Matula Tea to his clients and claims that not a single one has tested positive after a month of it.

      Best of luck to you. I have lived with this knowledge for three weeks and have come to feel a bit like a walking Holiday Inn for uninvited guests. In addition to the H.P., I have a non-human parasite and a fungus. Neither was specified.

      Much care to you and continued gratitude to Paul and Shou-Ching and this blog.

  10. Hi Paul,

    Was trying to find a silicon supplement per your recommendations – could only find BioSil which has an additional 100mg of choline with the 5mg of silicon. Is this ok? And couldn’t find the NOW Iodine … Thanks for your help!

  11. Hi Paul,

    Based on http://jama.jamanetwork.com/article.aspx?articleid=200903#joc50021f2 we think it prudent to feed our baby girl small amounts of gluten starting at 6 months. In Belgium, this means adding a hard biscuit made from refined flour to the daily fruit mash.

    It’s pretty hard to avoid your infants having gluten so we’d rather minimize chances of gluten sensitivity.

    Do you have any thoughts on this?

    • Hi Wout,

      Interesting paper, thanks for bringing it to my attention.

      First, keep in mind that heightened immune sensitivity to gluten clears toxins from the body faster. People who had impaired IgA generation in response to wheat developed kidney disease and other problems. So gluten sensitivity may be advantageous in some respects – it will cause a stronger anti-gluten response at the gut but might keep the rest of her body safer.

      It all comes down to how much gluten you think she will eat. If she’ll eat it rarely, then I’d rather have the immune system view it as a threat and remove it. If she’ll eat it often, then you should probably immunize her with it as you’re thinking so that it is treated as a food.

      • Ah I didn’t know about the immune system dampening, thanks!

        Yeah it looks like gluten is pretty much unavoidable while being nice and fitting in. Her elder sister now goes to kindergarten and they get a daily Petit Beurre biscuit (8.3g, containing 73% Wheat Flour, Sugar, 13% Butter, Skim Milk Powder, Salt, Leavening (Sodium Bicarbonate, Ammonium Bicarbonate, Citric Acid), Natural Flavor).

        It’s a bit annoying that they do that but on the other hand it’s only 8g and imagine that she’d be the only kid not allowed to have one, every single day. At least it has butter 😉

        I’m already happy that she eats her daily “breadbox” filled with rice/salads/potatoes/carrots/meat/fish etc without issues. It’s disconcerting to realize how much today’s children are exposed to wheat and sugar.

  12. I have started the way of eating and am finding good results..my question concerns oils. What is the advice when it comes to Grapeseed oil..
    my husband is not care much for coconut oil…so switched to cooking with grapeseed oil…please let me know what the story is on this…
    thank you,

  13. Hi Paul,

    Although I generally try to keep PUFA relatively low, there are days when I eat restaurant meals that are very likely to be high in omega-6 vegetable oils. I’m wondering if, on such high omega-6 days, it would be better to try to achieve omega-6/omega-3 balance by consuming extra omega-3, or to avoid omega-3 to keep total PUFA lower?

  14. First of all, THANK YOU for all that you do! I have been reading lots of posts and questions on Iodine. I read somewhere that topical tincture iodine is just as good or better than oral iodine. What are your thoughts on using topical iodine for Thyroid health?

    • Hi Arlenena,

      I think it’s excellent for relieving a deficiency and supporting thyroid health. It’s the safest way to take iodine. But it’s not as effective at getting you to higher doses that may be therapeutic for certain conditions.

  15. Hi Paul:

    I just purchased The Perfect Health Diet through Amazon. I decided to buy the book instead of just reading your website because I must be doing something wrong. I am on very low carb because EVERYTIME I eat white rice and potatoes back, I get major fungus in armpits — and then it spreads. Along with fungus, I start to experience major anxiety symptoms. I even try to stay in 200 calories range. Should I quit eating all starches or is it the fungus just leaving the body? If you don’t answer, I’ll wait until the book arrives and maybe the answer is already in there.



    • Hi Sue,

      That’s quite unusual. Has your doctor confirmed that that is a fungus attack? More commonly it would be some kind of immune activity stimulated by gut microbial activity.

      I would ask my doctor for a stool test and also get the underarm growths cultured if you haven’t already.

      If they are fungi, then it suggests impaired immunity which could be copper deficiency, chromium deficiency, iodine deficiency, or some similar problem. Eating liver, kidney, shellfish, and seaweed might help.

  16. Hi Paul,
    In my effort to continually tweak my diet to make it just right I have recently (in the last 1-2 weeks) started to up my fat intake to be more in line with PHD. According to Fitday tracking my fat intake generally hovers around 35-40% and at that I feel fine. However, when adding more fat, by way of fattier cuts of meat, more eggs, more heavy cream, more butter, I feel perpetually nauseated. The only thing I can think is that it is a gallbladder issue, but that seems unlikely considering I ate little fat before starting PHD 2 years ago.. so I wouldn’t have had the chance to develop gallstones. So, any thoughts on this? Can this be indicative of a greater issue or are some people just more sensitive to extreme high fat intake?
    Thank you!

    • Hi Lindsay,

      Well, first of all I’d stick with levels of fat that you tolerate. You can be very well nourished with 35% of calories as fat.

      Then I’d try to figure out what’s going on. I’m guessing the “irregularity” is steatorrhea? Difficulty digesting fats may be due to lack of bile, so you could try supplementing vitamin C and taurine, or taking ox bile with fatty meals. If you can clarify the problem then it will be easier to tell if it’s improving or getting worse.

    • Volek & Phinney say the opposite, that you can get gallstones from rapid weight loss and too little dietary fat. The gallbladder doesn’t get prompted to empty itself.

  17. Oh, I forgot to mention.. not only nausea, but also heartburn with more fat and my usual extreme regularity has become… irregular.

  18. So happy to see that your new book is available for pre-ordering. I can’t wait to receive mine. I’ve already been getting excellent results since I resumed this method. I just can’t thank you enough.
    Question–wondering about the acceptable foods and beverages that would not hinder the fast. According to what I understood from your reply to my last questions, leafy greens are unlimited. So during my fasting time– until about 1:00 or 2:00 PM, I make a green smoothie, no fruit but I use Coconut water and sometimes I add Coconut butter since it’s a pure fat. It makes the smoothie delicious. The other day I noticed that this butter is quite calorie rich. Are these beverages and butters ok when fasting–also how about raw Cocao in a smoothie when fasting.

    • Hi Isa,

      They’re OK in the sense that they’re not unhealthy, but whether they’re desirable depends on your personal goals. If you’re trying to lose weight, the extra calories are an obstacle. But if you’re trying to improve neuronal healthy, the ketones from the coconut butter and nutrients from the green leafy vegetables will probably help you.

      So, there are pros and cons to having this sort of “breakfast.” You have to decide if it’s right for you.

  19. Paul, looking forward to the new book!

    I’m following PHD as well as the chronic infection strategies due to recurring flare-ups of a herpes virus, VZV. The autophagy aspect of fasting is important to me so I want to make sure I’m implementing the fast correctly.

    When fasting for 16 hours, will I still be inducing autophagy if I’m consuming coconut oil and heavy cream(with coffee)?


  20. Hi Paul…
    My doctor just diagnosed me with leaky gut and my blood tests show I have severe egg and dairy sensitivities. I know you recommend eating a few yolks a day, but with such bad sensitivities, should I avoid them altogether? If so, how can I be healthy without yolk (or liver) in my diet?

    • Hi Hadley,

      Definitely eliminate egg whites and dairy protein; see if you tolerate egg yolks, and clarified butter/ghee should be OK.

      If you have to eliminate the egg yolks, the best thing is to replace it with 1/4 lb beef or lamb liver per week plus 1+ lb chicken liver.

      Do you not want to eat liver?

      • Thanks, Paul. Ghee seems OK. I’m having trouble gauging whether or not egg yolks are. It’s not that I have a problem with eating liver, but I haven’t been able to find grass-fed beef or lamb liver anywhere where I live (checked healthy grocery stores, farmers markets, butchers).

  21. You should be able to find some good options in your area at http://www.eatwild.com

  22. Many will ship, so distance shouldn’t be an issue.

  23. Dr. Jaminet,
    This is actually a question: is it possible that warfarin compounds inflammation in the human body.

    Since being placed it for “life” due to 2 DVTs and PEs, I experience the most painful delayed onset muscle soreness ever after weight lifting an other intense exercise. It occurred to me that that may be a function of my anticoagulation therapy (which I’d rather not be doing at all).

    I’d be grateful for any insights on how to remain healthy in spite of the potential of warfarin to seriously damage blood vessels, interfere with calcium deposition and contribute to onset of osteoporosis. The hematologist I work poo-poo the idea that treatment with warfarin contributes to any of this.

    Dave Brown

    • Hi Dave,

      Personally, I think it’s a good idea to supplement vitamin K2 even if you are taking warfarin. Warfarin interferes with vitamin K action but it is still necessary to have some.

      I don’t know if that would relieve your pain, but you are right to be concerned about promotion of arterial calcification and other problems by warfarin.

      • I’ve been wondering this too since my husband has been on Warfarin for over 25 years (he has to take it his entire life because of an artificial heart valve they put in at age 13). The idea is so that a blood clot won’t be able to form on the artificial valve. We hate that he has to take it, but don’t know any other way around that. I often wonder if ginger would do the exact same thing as warfarin and he could get off warfarin and switch to ginger! But I have never found a definitive answer and it seems too risky so we won’t be trying that. Oh how great it would be to find a naturopathic nutritionist cardiologist!

        Would the vit K help reverse any already-present arterial calcification?

        I know for sure that if he adds vit K, they will have to increase his warfarin dosage. A few weeks ago we thought his blood might have been too thin (I try to balance our meals with the ‘thinning’ foods (garlic, ginger) AND the ‘thickening’ foods with vit K (spinach, greens, etc.). But for a few reasons we thought it might be too thin, so he took one of my vit K2 (100mcg) that evening. He had appt to check his blood next day and his number was a little below the low end (meaning it was a little too thick). So, if he took the vit K regularly it would mean more warfarin.

        I know you can’t prescribe here, but we really value your opinion. So does adding vit K, even though it would mean increasing warfarin, sound better to you than no vit K? (I mean besides the greens he eats a few times a week). I feel confident myself with that idea because I almost can’t stand it whenever I start thinking about his poor arteries after all these years.

        Thanks Paul!

        • Hi KH,

          My personal feeling is that more K2 and more warfarin would be better than K2 deficiency and a low dose of warfarin. I think there’s some evidence supporting that in our book. It’s speculative, so no guarantees. K2 is less pro-clotting than K1, so taking K2 would be better than large doses of spinach.

          • That sounds best to me too. I think he might try adding the vit K2 supplement 3 times a week then check his blood that first week so the Coumadin clinic can adjust his warfarin accordingly, and as long as he’s consistent with the vit K, it should work fine. Then we can work up to daily vit K from there, if it seems to be keeping steady.

            I have to go back and read that section in your book. I remember reading it months ago, but I’ll have to reread it.

            Thanks Paul!

          • Dr. Jaminet,
            My warfarin dose is already 10 mg and has been as high as 14 mg. I usually go between 10 and 12 mg to keep my INR in range.

            I’ve seen some research that says low dose (45-50mg) vitamin K2 provides protective benefits w/ the added benefit of stabilizing INR. Have you read this info?

            I do not want to increase my warfarin dose much higher but if 90-100 mg of vitamin K2 will be of more benefit than 45-50 mg, I might have to do so. Any opinion on that?

            Thank you.

          • Hi David,

            Yes, we have a discussion of that point with citations in our book.

            I think it would be worth an experiment to see how much your dose has to change if you increase K2. It might not be as much as you think. I do think 100 may be significantly healthier than 50, but if you eat a lot of fermented foods / aged cheese then diet may already be providing 100.

      • Thanks a million, Dr. Jaminet. I have been doing the research on vitamin K2. That may be best bet. I am really looking forward to buying your new book.

        Dave Brown

  24. Rice crackers?
    I am resolved to try the liver thing. Never could eat the stuff and when I became concerned about the potential for toxicity I figured I wasn’t missing out. Paul has convinced me, and I am presently showing an allergy to eggs. Interested in the liver pate with some king of cracker, however the rice crackers in the photo look to be Trader Joe’s. Last time I looked, those were made with safflower oil, which I can’t tolerate for the pronounced joint pain they cause me.

    Anyone know of something I could use with the liver pate?

    • Lana, The only crackers I’ve found with none of the verboten ingredients are available at Walmarts. They come in a small foil bag. I’m not home, so I can’t tell you the exact name, but IIRC, the words “World” and “Rice” are in the product name. They come in several flavors, one of which is “Chili.”

      Not great, but palatable.

      I also use cucumber slices as platforms for things like egg salad.

      Quaker makes a rice cake that is free of unwanted ingredients as well. They’re palatable with soft cheeses and other toppings.

      Good luck.

      • Thanks, erp!! I’m testing positive for allergy to cukes! 🙁 But am hoping many of my allergies disappear with the demise of my pathogen. Will check the rice cakes.

    • Whole Foods sells rice snaps which are fat-free crackers.

    • My favorite safe crackers are Yehuda gluten free matzoh. I find them at whole foods. The ingredients are: Tapioca Starch, Potato Starch, Potato Flour, Pressed Palm Oil, Natural Vinegar, Egg Yolks, Honey, Salt.

      They also make a toasted onion version that I think would pair well with liver. I also find it at whole foods.


      • Thank you, Carol. This sounds good, except that the recent allergy test indicated I am one of those who should avoid nightshades. Didn’t think I was, but when I did the ten days without everything allergic on my test result, I felt remarkably good. This is very irritating, but I have had such an improvement in airborne allergies since treating the H.Pylori, that I am holding out hope for my food allergies.

        • Nightshades! Oh no! It’s bad enough I can’t eat most seafood, but I’d keel over without potatoes and tomatoes! It’s seems that so many of us have issues. I wonder if our guts get healed, we’ll be less sensitive?

  25. Hi Paul!

    I’ve been toying with paleo/low carb for a while, and hadn’t tried really low carb levels until about a week ago, when I went zero carb for about 2 days just to see what it was like. The night of the 2nd day at about 3am, I got really serious carb cravings and binged on some tostitos. Again, this was just an experiment so I didn’t mind the relapse. Lo and behold, the next morning I had an outbreak of some kind of rash that I had never had before. Over the next few days, it gradually spread all over my chest and face, as well as my armpits and groin. I had read before that on carb refeeds after long periods zero carb, opportunistic yeast infections can spring up, so I just kind of assumed it was that. After reading on your sight how glucose plays an important role in fungal immunity, I was convinced. I also didn’t sleep one of the zero carb nights, further blunting any semblance of a proper immune response. I tried to let my immune system fight it off, but it just kept spreading over the next couple of days, so I went to the doctor. He seemed to think it was a direct result of the “crash diet” I had done, but I think he saw it as an allergic reaction, and gave me some prednisone. The prednisone is so far giving me some pretty severe anxiety and messing with my already screwed up sleep schedule. Do you have any advice? I read on your sight that you’ve had a similar rash before on low carb. What did you do to get rid of it? Thanks so much.

    • I think the prednisone is risky, it just suppresses your immune function which could backfire if it has real work to do. I would expect that whether it’s an infection or an allergic response, since it sprang up in a few days it will clear in a few days. So I would eat a normal healthy diet free of immunogenic foods but with normal amounts of carbs and nutrients. If it is a fungal infection, presumably you are deficient in some nutrient that is important for fungal immunity, like copper or chromium or vitamin D. So in addition to carbs I would eat some beef liver and take extra vitamin D3 also.

      • Thanks for the advice! I’ll definitely add some D, Chromium, and Beef Liver. I had another question regarding general autoimmune issues and inflammation. I’ve had acne for a while, and the prednisone seems to have gotten rid of my acne temporarily. I’m guessing this is because the prednisone is suppressing the immune response that causes the inflammation. My question is, if the prednisone suppresses my immune system, and my acne goes away (showing that my acne is at least partly due to autoimmune issues), then what is causing my autoimmune problems. My mom has always had autoimmune issues, and so I can’t help drawing a correlation between my acne and her skin related autoimmunity.

  26. Dear Paul and dear Shou-Ching,

    there is a little confusion from my side concerning the protein restriction.
    in your book you recommend, if healthy, between half and one pound meat a day. so if i understood it right it means up to 454 g a day-which is more then i usually eat (between 200-300g a day protein) but in that paleolifestylearticle (http://paleodietlifestyle.com/paleo-and-protein/) it is limited to 180 g for men-so did i get it right from your side or is my translation to gram wrongly?
    anyhow with our daily intermittent fasting we have mainly two meals, with 2-3 eggs at noon and not every day but mostly some meat or fish later.
    so i have the feeling we are in the restriction frame. what do you think?

    one more question: recipes: you have this amazing recipes where you show, sometimes with some nice asian influence, how to have healthy (20/60/15) meals-especially the question of how to get enough fat in a creative way.
    is there a thought of writing a small recipe book? i would heartly encourage you to do so, if you also feel so.

    warm regards to both of you,

  27. So after a lot of self diagnosis, I bit the bullet and went to a very reputable (at least I think so) alternative medical doctor who treats the body in a more a holistic way. Many tests were performed, but thus far, only one came back was a pretty extensive swab in the rectum ( I can’t recall the name of the test). They said there is an intestinal imbalance overgrowth of bacteria. They said this can cause symptoms similar to a parasite. I return next week, but in the mean time they recommended berberbine plus. Paul or anyone know anything about this or have a similar experience?

  28. I continue to be stumped to find a low dose iodine. The NOW brand has stearic acid which gives me pronounced joint pain. A search netted me nothing but discussions of diagnosing cancer.

    The Edgar Cayce Atomidine is the lowest I can find, but if it can spontaneously combust, then, obviously I need a different product.

    Anyone know of a low dose, comparable to the NOW product that I can check?

  29. Hi Paul,
    Acknowledging whole foods being superior, what is your opinion of grass fed desiccated liver pills? Thanks.

  30. Do you recommend taking NAC for us migraine sufferers early on our fight, or later on, when symptoms have significantly improved, as per Kate’s story?

    • Hi Faisal,

      In regard to supplements I recommend doing controlled experiments in which you try things one at a time to see if they help. If they do help, then I recommend taking them, but periodically repeating the experiment by stopping them, because sometimes they can help for a while (repairing a deficiency) and then start causing harm (creating an excess).

      To do a controlled experiment, you should have your diet in a stable state first.

      • Ah alright. So far things haven’t improved substantially but I partially blame it on myself as I have not been strict enough about what I eat, so I ordered MCT Oil to help me on my second weeks bout. That said, what do you think a typical day should go like?

      • Hm, I see you’ve suggested:

        “200 starch calories, no fructose, 400 protein calories, lots of MCTs. That is the safest, healthiest form of ketogenic diet.” and “4 tablespoons of MCT Oil”

        for epileptics ketogenic diet. Add in sauteed vegetables (in butter) for whenever I’m hungry. Will this do?

  31. 👿 👿 👿 👿 👿 👿 👿 👿 👿 👿 👿 👿 👿 😈 😈 😈 😈 😈 😈 😈 😈 😈

  32. Thank you, doctor!

  33. Paul,

    As a part of my coursework for health coach training I am reviewing the variety of diets out there. I am personally paleo and PHD.

    In reading Dr. Sears Zone Diet again, I find his disdain for the AA in egg yolks and they are on the NO list. Wondering what you think about that?


    • I think normal food amounts of AA are healthful. You can find particular persons or conditions where the AA might be problematic, but for the most part the quantities we get from food are in line with the quantities we utilize each day, and so dietary AA mainly downregulates conversion of linoleic acid to AA.

  34. I don’t know if Paul concurs but here is some info I found regarding the AA concerns in egg yolks.

    Docosahexaenoic acid (DHA) and Arachidonic acid (AA)

    DHA is the usable form of omega-3 by the body and arachidonic acid is the usable form of omega-6. Compared to those, omega-3s from ALA (Alpha-linolenic acid) and EPA (Eicosapentaenoic acid) and the omega-6 LA (linoleic acid) need to be elongated before being used by the body. Egg yolks bring both DHA and AA, the two truly essential fatty acids. Consuming omega-3 rich eggs is also a good idea to keep the n-3/n-6 in a good ratio in your diet.


  35. Paul…if one has egg allergies, does it help in any significant way to try and remove the yolk sac prior to adding the yolk to the meal?

  36. Paul,

    Thank you for your wonderful book that is helping me feel better than I ever have!

    I am new to the diet and trying to learn how to adapt it to my specific needs. I am a longtime migraine patient and have learned to avoid all potential migraine triggers especially nuts, chocolate, avocados, aged cheese, and anything fermented, such as yogurt. Do you know if there are tyramines in coconut oil? What about coconut milk? I am nervous about incorporating potential triggers in my diet.

    I feel great but seem to be hungry all the time. I am a slender (5’7′ 118 lb) person and am struggling to eat enough fat to stay healthy. I have always eaten lots of fish, salad, and vegetables. Do you have any other suggestions for me?

    • Hi Carolyn,

      Coconut oil doesn’t have tyramines. Coconut milk often has guar gum or other stabilizers that can be fermented in your gut; it is possible these might cause a bit of trouble. I would give it a try and see, but favor the oil.

      Hunger suggests some sort of nutritional deficiency. It could be a macronutrient (eg too few carbs or protein) or micronutrients (eg choline — do you eat egg yolks and liver?). I would try eating around 30% carb / 20% protein / 50% fat which is a good ratio supportive of athleticism and muscle growth, and try to make the diet as nutrient dense as possible. Also, note that we have new supplement recommendations on the top of the supplement page.

      If you aren’t already, try eating a pound of potatoes per day and see if that eases your hunger.

      Best, Paul

  37. Hi Paul,
    One of my friend told he was taking iodine without “cofactors” and had very bad symptoms which dissapear when taking togheter with Selenium, Vit.C …especially selenium.
    I was wondering if you heard of something similar.
    I am expecting my Iodine and want to be sure its’ ok to take it togheter with the supplements: vit.c, selenium…

    thank you,

    • Hi David,

      You definitely need to have good selenium status for proper iodine handling. Other cofactors like magnesium, copper, and iron should also be in good shape, but selenium is most important.

      Either too high or too low selenium will cause trouble. Our diet is selenium rich (beef, lamb, shellfish, seafood, eggs) and we recommend eating kidney or occasional selenium supplementation to help ensure good selenium status.

  38. Paul,
    Many thanks for your answer. I assume I should take Selenium supplement as I cant eat and digest red meat beef, lamb…due to my condition. Shellfish is a fairy tale for us here :).
    Although I eat like 3 eggs per day.And I can have brazil nuts but also cant digest them.

    Is there any solution to avoid goitrogenic effects of cruciferous? I’ve noticed when I’m eating brocolli or cauliflower I have a megahunger after 10-15 minutes and last until I eat mega food:). I presumed is because they impaire the tyroid function. The hunger I feel is under my tongue and in the right upper part or the abdomen. Or could this be cause by bacteria or parasites I have? but is not happening with other foods?

    thank you,

  39. Hi Paul, I’m confused about protein needs and appetite. My doctor advised me to eat at least 60g protein a day. Since I can’t eat eggs, dairy, nuts or protein powder, my only source of protein is meat and fish. Problem is I don’t have the appetite to eat enough meat to get 60+ grams of protein. If I feel full eating less protein than he’s recommending am I getting enough or do I need to make myself eat more in order to get at least 60g?
    Thanks, Hayley

    • Hi Hayley,

      Your doctor is right about general nutritional needs. That’s the amount in 1/2 lb of meat or fish and that’s an appropriate, healthy amount of protein for a woman to eat.

      Normally lack of appetite signifies that you are not deficient in anything important, such as protein. So if you are healthy then lack of appetite will be a good signal that it’s OK to eat less for a while. When you need the protein your body will tell you to eat more.

      However, it’s possible for this appetite regulation mechanism to become broken. We see that most extremely in eating disorders like anorexia, where people don’t eat enough even though they are clearly deficient in protein and other nutrients. In such cases it’s important to eat even if you’re not hungry.

      I don’t know what’s going on in your specific case. You have to judge for yourself what your body needs and whether your doctor’s advice, which is generally sound but maybe not for everyone, applies in your case.

      I can tell you that some elderly women do get by just fine on 40 g protein per day. Protein needs do diminish with age. We generally quote 50 g protein per day as a minimum for middle aged adults; your doctor’s 60 g protein is also a reasonable estimate.

  40. Thanks Paul. Is 8oz the measurement of the meat raw or cooked?

    I don’t think I have anorexia. I’m just very short and only weigh 100lbs. I’m in my 20s, is 50g still a good minimum for me?

  41. Hi Paul,

    I really enjoy reading your insights on nutrition, as this is something I want to research and study in my future career (research scientist and MD!). However, in a week I’m going to be moving in to university as a first year! I have to buy my own food and make it. Yes, I’m a decent cook, but I will be on a very limited budget. Do you have any advice/suggestions for the oh-so-poor college student trying to stay PHD compliant?

    • Hi Rosa,

      Rice, potatoes, eggs, and dairy are cheap. Water is the cheapest drink. Get meat on sale, and buy organ meats from local farmers — often you can get those for free or very cheaply. Make friends with local farmers. Find a source for fish or shellfish. Get some bones and use them to make soups. Use butter as your main fat.

      And have fun!

  42. I’d love your opinion regarding Yacon root syrup. I’ve read that it is a low-glycemic sweetener and that since its sugar consists of frutooligosaccharides, (FOS) it passes right through the body mostly unmetabolized. These undigested sugars serve as food for friendly bacteria in the small intestines and colon. I love its less-sweet taste. Might this be a possible PHD sweetener we can add to the sweet list.

    Just one more question: I’ve heard many times that cruciferous vegetables should not be eaten raw. I think it has something to do with thyroid or adrenals–don’t remember the reasoning. I hadn’t paid much attention to this b/c I love my green smoothies made from cruciferous vegetables and I haven’t noticed any problems so far, but after reading this comment (below) I wonder if I should continue my green smoothie practice. I know that you would have the real facts. What do you think of this:
    “The vegetables used in green smoothies are almost without exception high oxalate foods. Over time, a high oxalate diet can contribute to some very serious health problems particularly if you are one of the 20% of people (1 in 5) that have a genetic tendency to produce oxalates or if you suffer from candida or other fungal challenge. In those cases, a high oxalate diet can deal a devastating blow to health.”

    • Hi Isa,

      I don’t think we need a lot of FOS, which can distort the gut flora. I prefer to just eat natural foods. But if you tolerate it well and like it, the Yacon root syrup is probably fine.

      Cruciferous vegetables are definitely thyrotoxic. As always the dose makes the poison. I would alternate vegetables in the smoothies and I would not include crucifers every day.

      An 88 year old woman went into a coma from eating 2 pounds of bok choy per day: http://www.nejm.org/doi/full/10.1056/NEJMc0911005.

      As for oxalates, yes, some people are sensitive to them.

  43. Hey I’m on the PHD diet. And sticking to it. But lately ive been had very bad brain fog. So bad to the point to where my typing wpm have gone down, and cant think very fluidly. Getting enough animal fat, and safe starches as well.

    Have been sticking to the supplement guidelines on your website and have been working out (freeweights and interval cardio)

    Wondering if you had any ideas as to what is causing the brain fog?

    I noticed you recommend Lithium. Do you think that will help with the brain fog?

    Thanks for your time Paul, I appreciate your insight.

    • Hi Caleb,

      First, are you following the updated supplement guidelines? These have lower doses. Possible supplement overdoses that can cause neuropathic symptoms include manganese and selenium. Also, any thyroid problem can induce brain fog / confusion. If selenium or iodine are off then there is potential for thyroid issues. So I would try stopping supplements for a few weeks, then switching to the updated guidelines.

      Low-dose lithium is probably beneficial but I doubt lack of lithium is behind your issue.

  44. Oh thank you so much, Paul. I’m guilty of the concept–if something is good, more is better. Intuitively, I knew I needed to research the Green Smoothie revolution a little more. So grateful for all your are doing in service.

  45. Hi Paul,
    I wonder what your thought is on this: When I drink coffee (which I don’t often do), I can smell the strong coffee odor in my urine for a few hours. Does that mean that I am not digesting the coffee well and/or have a ‘leaky gut’? I’ve never heard of anyone else with that symptom and I’m wondering if this might help me to understand some of my health issues.
    Thanks for any insight!
    ps- Your first book was great– I can’t wait to read your second one! Thanks for all your hard work!

    • Hi Laura,

      I don’t know what it means. It may mean that your liver isn’t metabolizing them as well as most, so your kidney has to do more work.

    • For what its’s worth, Laura, I experience the exact same thing with coffee. I’ve always wondered if I was the only one, but I didn’t ask my co-workers since it’s not exactly your normal office room subject matter 🙂

      • I guess the test is, can you smell coffee in someone else’s urine?
        If so, you just have a hypersensitivity to the smell.
        If not, it’s your metabolism.
        And if you’re caught doing this test, you’ll never live it down.

      • Hi Thomas,
        Thanks for the reply- it’s nice to know I’m not the only one! For what it’s worth, I used to drink a lot of coffee years ago and never smelled any coffee odor in my urine. But, once I got Lyme disease, everything changed. I am still not ‘right’ even though I’m technically cured of Lyme. I’ll have to look into Paul’s suggestion of liver function, since it makes sense with all that’s happened to me.

        • Laura,

          If it helps at all–I have the same thing with coffee and have a well functioning liver (which I know from many blood panels over the years). So, at least for me, it’s not a liver issue. Maybe it’s like the whole asparagus thing? Some people have smelly urine after asparagus consumption and others do not. Do let us knowing you figure anything out.


  46. Hi Paul

    Just read the press release of the EU study called the Diogenes project:

    Diogenes press release English

    They promote a high protein-low Glycemic diet. What is your take on that?

    Best regards

    • Hi Lars,

      Well, we’ve known for a long time that high-protein calorie-restricted diets are great for short-term weight loss. All the viral diets have this form – Atkins, Dukan, etc – because people get excited by early results.

      Unfortunately it’s not the optimal long-term approach, obesity is simply not a protein deficiency disease, and it generally does not lead to permanent sustainable weight loss and weight normalization.

      Best, Paul

  47. Here is the page with the press release link:


  48. Paul, I find that I feel very full after eating for a long period of time and I become very tired after eating as well. If I eat later than 7pm, I wake up feeling full the following morning. I find it difficult to eat in an 8-hour window because when its time for dinner im usually still full from lunch.

    Also, about 20mn after eating I get very fatigued with brain fog, usually my sinus congestion/pressure starts up and I’m actually prone to feeling somewhat depressed for a period of time. I’d say I have decent digestion otherwise, maybe a little gas, 1-2 bowel movements per day. No stomach discomfort other than feeling very full and maybe bloated as well.

    Any thoughts on what I can do for this and what the underlying issue is? Thank you much.

    • Well, it sounds like you’re not digesting food well and getting a lot of food proteins into the body after a meal, giving your immune system a lot of foreign “toxins” to clear.

      I would start by trying betaine hydrochloride with your meals to try to improve protein digestion – maybe try digestive enzymes too. See if that helps.

      • Paul, thanks for the quick response. I’ve been taking enzymes with my meals for the past few days with little or no improvement.

        I’ll add HCL as soon as I can get my hands on some, I’ve heard Now Foods Superenzymes with HCL are a good brand.

        I’ve been on teh PHD diet for a few months but I haven’t implemented broth into my diet yet. I’ll start that this weekend! Thanks again.

  49. How do you feel about cheat days? I know some diets allow one per week, do you think that’s a bad idea?

    What about less frequent then that? I’ve been on the PHD for 3 months, and was thinking about cheating and having pizza and cake for my birthday. Is an annual cheat day likely to be risky or have long term effects?

    • Hi Isaac,

      On the one hand I don’t think an occasional cheat day does much harm, on the other hand I think if people feel “cheating” is necessary on a frequent basis then there’s probably something wrong with the diet.

      Personally I find our food delicious and satisfying and feel no desire to “cheat.” However, sometimes when traveling it’s inconvenient to find PHD food, and I’ll eat something forbidden. That happens maybe 3-4 times per year for me.

      One thing to consider is all the supercentenarians who refuse cake on their birthdays – I think Leila Denmark said she hadn’t had anything with sugar in 70 years in explaining why she refused her birthday cake. If you want to squeeze out an extra year on the back end maybe you shouldn’t cheat!

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