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. I would love to hear Paul (or anyone else’s) experience or thoughts on IV hydrogen peroxide to fight any infection. My understanding is that infections, even viruses cannot live in the presence of hydrogen peroxide. I have a sister who has a chronic viral infection, not sure what it is specifically yet, and we want to explore IV hydrogen peroxide therapy.

    • I’m going to get IV hydrogen peroxide along w/my C next week. I’ll report back.

    • Human cells can’t live with it either if the dose is high enough. I’m not familiar with this therapy, so I can’t tell you whether it would work or not.

      • Following 100 grams of IV C, I then had 2.5ccs of hydrogen peroxide buffered with manganese! and magnesium. This is in a 250ml solution which took about 45 minutes to infuse. Talk about a toxic brew. As usual, I don’t feel any different post IV.

        Frankly not sure if I’m going to repeat the peroxide, and am growing weary of the IV. Going to leave a separate comment/question for Paul relating some new information.

        • Well, after that I hope you feel some relief soon! Are you being treated for an infection? I keep hearing how great a treatment is for infections, and from people in my community. The infections were all candida related though.

          • Shawn, I went back to my detox community site to listen to part of a recorded conference call where one of the members called in to ask about IV HP for a chronic viral infection (did not mention what the infection was). The suggestion from the expert of this community was to find a good integrative MD to explore HP IV treatments, and her thought was that she would need maybe 10 treatments!! After what Paul said about human cells not being able to live in an HP environment, I don’t know what to make of her recommendation. The IV HP treatments were something I was considering seriously when my first blood tests came back with markers for a chronic viral infection, but now, I’m not sure what to do. I will have that panel run again in January. Keep us posted.

          • Thanks Dede, yes I have a chronic epstein-barr infection (human herpes virus 4). For now the protocol is C infusion 2-3 times a week, 2 grams a day of Valtrex (with a 90-day script), and possibly some peroxide. Also was just diagnosed with GERD.

            My integrative med. doc seems to like peroxide for infections but I haven’t done any of my own research. I’ll respond back if I find anything useful. Perhaps peroxide is helpful for candida and not necessary for viral infections. I think the concensus on C is that it doesn’t help candida.

  2. Best of luck Shawn, my fingers crossed for your recovery! I can’t wait to hear your report.

  3. I am transitioning away from GAPS because I am curious about adding glucose to my diet, but have some fear about rice. I was diagnosed with celiac disease in June (no digestive symptom CD, the brain fog, weakness, fatigue kind of CD). Anyway, does anyone have experience with celiac and rice? Is white rice best? I am awaiting the new book, so I apologize for not having all of the information and asking what are possibly obvious questions. 😉

    • Rice is very well tolerated by celiacs, but it is a grain and doesn’t supply the amounts of minerals, vitamins and “resistant starch” fibre that you’ll get from starchy roots, corms and tubers (which IMO is the best sort of fibre for rebuilding gut ecosystem). Any of these can supply glucose.

    • Chris Kresser just posted some very good information about rice(what to be careful of) that you may want to check out.

      How long did you do GAPS for? Did you notice any healing?

      • Thank you George. I appreciate the feedback. I wish I loved sweet potatoes. I am avoiding nightshades because of the inflammation from celiac, unfortunately. Can I ask what IMO is? If IMO is bet fibre for healing my small intestine, than I want to try that for more carbohydrates in my diet.

        • Thank you Heidi, I saw that, but haven’t had a chance to read it yet. I love Chris Kresser’s site!

          I did the GAPS Intro Diet for 3 weeks, since I had no digestive symptoms from celiac, I breezed through the Intro steps. I did see improvement in my energy and strength, but no help with my brain fog, aches, etc. I was taking the GAPS recommended probiotic BioKult and could never find my therapeutic dose and I was up to 9 pills! I’d go broke taking 9, 10, maybe more a day! So, I thought this might not be quite right for me. So, I am now exploring other avenues (like PHD).

          • Paul made a comment, possibly in the bowel disease thread that GAPS+PHD was a good mix.(at least I hope I’m not misrepresenting) I’ve been wanting to ask what was meant by that, so Paul if you’re reading this, please chime in. PHD makes the most sense to me, but with a bowel disease it’s so hard to know how to implement everything when there is so much going wrong with digestion.
            IMO= In My Opinion 😉

          • Hi Heidi,

            I’m not sure what I said, but gut ailments are various and so there is no one set of foods that is optimal for all gut ailments. GAPS is generally good for colonic (large intestine) infections but for small intestinal infections the sugars may be problematic and the starch avoidance may be unnecessary or even counterproductive.

            So for gut ailments you generally have to personalize your diet.

        • Hi Dede, “IMO” is “in my opinion”.

          Rice is worth a try, as are potatoes. You can also try dextrose which is fiber free. You would like to build up to potatoes even if you can’t handle them at first, as their fiber is highly beneficial.

          • Oh! Got it! Thank you (Paul, Heidi and George) for the IMO clarification. I am anxious to try some “safe” starch. I have been so paranoid with this celiac diagnosis to try anything outside of non-starchy vegetables (and the very occasional winter squash) because I don’t have the outward, obvious symptoms like some celiacs do if something too fibrous is not agreeable to my body. As a matter of fact, before my CD diagnosis, when I ate gluten, I didn’t even feel that! But, I was on a SAD and just felt lethargic most of the time anyway. If I had to run to the bathroom every time, etc., I would know for sure what not to eat. I was only diagnosed in June, so I am in healing stages.

            Paul, or anyone who might know, how do I know if dextrose, white potato, or any other recommended safe starch is a good food for me? I didn’t see winter squash mentioned. Do you have an opinion on that? Anything subtle (symptom wise) to look out for that would tell me proceed or remove? Sorry for all of the questions.

          • Hi Dede,

            Usually if they’re bad for you you’ll experience symptoms of heightened immune activity after eating them, eg fatigue or brain fog. Just be sensitive and listen to your body. Do controlled experiments with each carb to see which you tolerate best.

      • Thank you George. I appreciate the feedback. I wish I loved sweet potatoes. I LOVE white potatoes, but I am avoiding nightshades because of the inflammation from celiac, unfortunately. Can I ask what IMO is? If IMO is best fibre for healing my small intestine, than I want to try that for more carbohydrates in my diet.

  4. alright KH, this is a long one & i have to start with an approach of understanding. this is 6 years of research and practice, and its still evolving. i think strategies must evolve with time.

    some ideas to think about:
    there are 5 types of crohn’s, and a few types of IBD. not including ibs.
    there are probably secondary and tertiary issues that co-evolve or take advantage of the weakness that an a.i. brings.
    everyone needs to know exactly how every food effects them in every situation.
    meditation and creativity and intuition training is KEY for all this. helps to control stress and make better decisions in every stress circumstance.
    movement is key, increasing circulation in every sense of the word. even metaphorically.
    try new things, always, never let the perspective get “set” or “certain”. learen to live well in uncertainty, holding different possible paradigms simultaneously. life is not binary.

    now onto details.
    train the immune system to be smarter: medicinal mushrooms, lauricidin, lactoferrin/colostrum, olive leaf, oregano oil, etc
    train the system to operate efficiently at low levels. basically stop leaking energy, you cant afford to. your 10% must be as good as a sloppy person’s 100%. another way to look at it is that you have a small and fragile vessel, but you learn to fill it with diamonds, while others may have stronger, bigger vessels that they fill with nickel.
    dont be afraid of simple sugar. it can beat stress. learn all the tricks of lowering stress rapidly.

    supplements: serovera amp – this reduced my symptoms by 50% in 1 week. fucking insane.
    a-l-carnitine & choline – clears up the brain fog.
    co factor b-vitamins, jarrow b-right.
    curcumin c3 with bioperine
    the above are anti-inflammatories that work different pathways. if joint pain is a big problem as it is for me add
    daily bone broths, eggshell membrane, undenatured collagen, hyalauronic acid, avoca asu, athletes joint restore

    TCM extracts like cordygen/cordyceps, astragalus, reishi, eucommia, salvia…

    really figure out your symptoms and pathology, even if there’s no diagnosis, look into athletic supplements for clues on optimizing health. diet is #1, but esoteric supplemntation is #2.
    when i say esoteric i mean even things like anabolic steroids, oxytocin, low dose lsd, stem cells, etc. never give up, theres always more weird shit to experiment with.

    a word on oxytocin – this is very intersting. do research on it – it helps both autisticcs and trauma victims, c-section babies have less oxy, oxy helps lower stress responses. it may be called the love/cuddle hormone, but may be more like the meditation hormone.

    l-theanine – the meditataion amino acid. super cheap.
    chocamine – chocolate extract, effing ridiculous. why is no one jumping on this bandwagon?

    • This makes sense Darius; carnitines are ggreat for brain fog.
      Consider low-dose naltrexone perhaps before the weirder shit.
      Also research whipworm and hookworm treatments.

      • yes ldn, i keep trying some every few months from the tablets i have in the fridge but goddammit i can NEVER tell if its doing anything at all lol

    • Thanks Darius, I’ll pass this on to him. I don’t know exactly what he has and hasn’t tried but maybe a year ago he was in a stem cell trial but nothing has happened from that, at least nothing obvious. He has used low-dose naltrexone but I don’t think he’s using it now. When I asked him about eliminating gluten, he said he tried it for 2 years with no obvious good results. After reading everything on gluten, it seems like anyone with gut issues should eliminate gluten completely. I know stress is a big factor lately for him so that’s not good. I haven’t heard of some of the things you listed but I’ll look them up. Thanks for all the info! I hope something will help him.

      To George- I did send him an article on some sort of worm treatment recently. I’m not sure his reaction though. I’m also the one that sent him the fecal transplant idea. Im not sure if his Crohns is in the colon though or not so that might not even be a good option if it’s not.

      • with gluten, even if its not apparent i feel im just better off without it. as for many of the other big ones: i dont do milk, but can tolerate some ice cream and chese with digestive enzymes, and i do eggs maybe once every 2 weeks. starches and fodmaps and big doses of lactose are obvious ones for me, as well as nut starches and phytates, and many raw veggies (cellulose, starch) but raw kraut is good for me. all throughout this struggle i was very depressed and often thought about suicide, but i am a very defiant asshole and a heavy meditator/hypnosis/nlp/shamanism person so i keep plunging into difficulty, not avoiding it. i would recommend anyone with a chronic disease to experience entheogens (lsd, mushrooms, ibogaine, ayahuasca, etc) to gain some legit perspective.

  5. Hi Paul, Shou-Ching and everyone,
    Anyone got any thoughts about high-fat diets and uterine fibroids? I’m wondering if doing a high-fat diet is causing my levels of estrogen to rise and my fibroids to grow… Trouble is I’ve been in a high fat diet to heal my gut, and clear chronic fatigue, so I’m not sure if there’s a conflict of interests…. Can anyone help enlighten me?

  6. Can anyone think of a reason why I failed twice in producing broth that contained even a fragment of geletin? I even used beef feet, which someone on youtube said they were able to produce 12 batches of geletin with.

    I simply put a beef foot and a segment of oxtail into the crock pot and covered with water. I included approximately 4 tablespoons of bragg apple cider vinegar and turned on the crock to low and let that puppy simmer/boil for 24 hrs. I put the broth into the fridge and upon taking it out 6 hours later had the suprising discovery of broth at the consistancy of water. Any thoughts?

    • Is it possible the crock pot never reached a boil?

      Ox hooves are usually pretty reliable.

    • Too much water?
      And was the beef foot already cut in half (exposing the… collagen??)?
      I don’t know, just guessing…

    • Hi Jon, I agree that it’s possible you used too much water relative to how many bones you had. But it’s also possible that you cooked it too hot for too long. Very long and hot cooking will degrade the structure of the collagen and prevent gelling. If you actually boiled it, rather than a slow simmer, then I would guess that’s a possibility, especially with 24 hours of cooking (that’s a lot!).

    • The first broth I made didn’t gel, but when I cooked my second batch, (on a gas stove top at a low setting, covered), it was like perfect gelatin, I could cut squares out of it! 🙂 I cooked it for a total of 15 hours dividing that time between 2 days. I put the whole pot in the fridge after the first day of cooking it. The bones I used were meaty soup type bones, oxtails and marrow bones. I have a 100% grass fed beef source. I have heard that grain ged beef bones will not gel.

      I hope this helps.

    • thehealthyhomeeconomist.com says 7 lbs bones to 4 qts of water. I need a foot or joint in the mix of bones to get gel. Oxtail has the joints, but still, I would weigh the bones to 7 lbs for a 5-6 qt crock.

      • I wish I could give you measurements, but I carelessly threw bones from grass fed cows (and lamb sometimes) in and poured enough water to cover. I didn’t really know what I was doing, but the second batch turned out so great, I just went with my “method”. Try enough water to cover the bones and see how it turns out. I did skim off foam (scum) when it started to boil also,

  7. Yeti definetly came to a boil, even though it was on the low setting. I put it on high next time.

  8. Hello Paul or whomever is available to respond to me. I’m new to this website and am looking forward to reading “The Perfect Health Diet” Book. I’ve gathered from surfing through this site that rice syrup is a suggested sweetener. I am concerned about the high arsenic reports lately. Should I avoid rice syrup at this time?

    Also, until I receive the book, does this site have posted info about how often and when to eat the safe carbs? If so, please provide me the location of this info. Thank you!

    • Hi Jeanette,

      It would be good to find white rice syrup, but even brown rice syrup is acceptable if the rice is grown in Asia or California. The arsenic comes from former cotton-growing regions of the US south.

      Safe starches should be eaten at meals. Include some at every meal. For snacks, use fruit.

  9. Hi Paul,

    A new Chris Kresser article about arsenic in rice has me really worried about my 17 month old twin grandchildren’s brains. They seem to be bright but I still find this article alarming because they have eaten rice often twice a day over the past year.

    They eat all the nutrient dense foods and a wide variety of other PHD recommended foods but a mainstay of their diet has been rice cooked in bone broth. Do you think my daughter should cut down on their rice? Because they don’t like potato or sweet potato much this would be difficult to do.

    I have read your previous comments about arsenic in rice and I had thought Australian rice was probably OK until I saw Chris Kresser’s article but now I see that the fine print on the packet of Australian certified organic rice says “rice from Australia and around the world”.

    Our whole family has eaten a lot of rice (and a lot of nutrient dense foods) since finding PHD more than a year ago and we have all experienced significantly improved health but in view of this article I am wondering whether we should be eating so much rice.

    Thanks again – your intelligence and kindness are appreciated every day.

    • Hi Francesca,

      The arsenic problem is fairly isolated to rice grown in former cotton-growing regions of the American south.

      I think your family should continue to eat rice. I would just be careful to look at where it comes from. Asian varieties are low in arsenic.

      Best, Paul

  10. Hi Paul or George H – would you by any chance know if low dose naltrexone might be useful in the treatment of fibromyalgia where the main symptoms are muscle pain and spasm of the back and neck and insomnia. Thanks, Lindsay.

  11. Hi Paul,
    i posted a query here
    which you may have missed,
    when you get a moment may be you could take a quick look & possibly point me to somewhere with some info on the subject


  12. Hi,

    I’ve been on the PHD diet for about two years now, and I really enjoy all the hard work that you put into this. My question is, “Is really low body fat bad (or not optimal) for a 22 yr old male?”

    After about a year on the PHD, I noticed that I lost nearly all my body fat while slightly gaining muscle. I am 6’2″ and ~175 lbs. I don’t “work out” but I do ballroom dance a few times a week. I have no problem with having little fat, or a little more fat. It was just unexpected, and a rather new phenomenon. Having a visible ~8 pack and being able to see some tendons and muscles move through my skin that I have never seen before is kinda weirding me out.

    I used to be VLC diet for a short time (month or so), and I lost a bunch of fat, but that was ~2 years ago, and since then i’ve really cut down on the protein and upped the fat (and the carbs to ~20%). I frequently am not particularly hungry (especially after breakfasts that contain your vitamin supplement recommendations) and I figure that I don’t eat as many calories as I used to due to the very nutrient dense meals I eat nowadays.

    Thanks for all your hard work and interesting analyses.

  13. Hi Paul,

    Can you give us your view on parasites and/or worms. Should there be a monthly or annual cleanse


    • I’ve just finished reading “An Epidemic of Absence” by Moises Velasquez-Manoff, which discusses evidence that some parasite infections are protective against allergies and autoimmunities.
      paul, is it possible to get rid of a harmful parasite (say, giardia) without dislodging anything beneficial?
      After reading the book, I would never purge parasites on a regular basis, or on mere suspicion, but only if I had good reason to want something gone, and then I’d try to be specific. I’ll also be far more tolerant of nuisance parasites like pinworm in future.
      We have a lot still to learn about this stuff.
      One man’s pathogen is potentially another man’s protector, in many cases.

      • An interesting point about the “hygiene hypothesis” epidemiology in “An Epidemic of Absence” is that the odds ratios are often much stronger than in most diet-health epidemiology. The impact of diet on microbiota might turn out to be more important than the direct metabolic effects.

        • George,

          I am currently reading it and all I can really say is WOW. Such an eye opener!

          He mentions briefly a few times that diet was considered many as a factor in the huge surge of autoimmune and allergy, but I do wonder still how a person on a good diet (PHD for example) without hookworm and a person on a “bad,” diet with a hookworm would compare. Which would fare better?

          So much food for thought.

    • Hi Bev,

      I don’t have specific advice for how to treat parasitic infections. I would suggest consulting a doctor with experience treating such infections.

  14. Is there an autoimmune protocol for PHD? I always hear about removing eggs, nuts, nightshades and dairy as a must for reducing AI’s inflammation.

    • We don’t have a specific protocol, but we would endorse most of the standard strategies.

      It’s good to avoid items that trigger food sensitivities. But in most cases these sensitivities are not the cause of the trouble, but a symptom; once the gut heals and is no longer leaky the sensitivities will go away. So the most important step is removing things like wheat that can create auto-antibodies and/or leaky gut.

  15. Dear Dr. Jaminet,

    congratulations to you (and Shou-Ching) for your excellent work. The book (and the site) is a wonderful and always insightful source of informations. I would love to read a post about dental health and how it’s related to diet (and gut health).

    Alex (from Spain)

  16. Paul, looking forward to the new edition in December!

    How about using nutritional yeast for supplementing b vitamins rather than purchasing synthetics? Or should the PHD diet(with 1/4lb liver weekly) provide for sufficent amounts of b vitamins?



    • Hi Jeff,

      It’s probably not necessary to supplement B vitamins, but we are now suggesting once weekly just because the risks are so low.

      Nutritional yeast is probably OK but I wouldn’t take them every day. I’m not aware of any problem with synthetic B vitamins however.

  17. Paul any suggestions for dealing with Raynauds(in addition to following PHD)?

    • Jon, My Raynaud’s has improved dramatically since switching from low/very low carb to PHD. (Also take many of the recommended supplements.) I think I’ve only had a problem once this past year where before I had it almost all the time during the fall/winter season, especially when grocery shopping and touching cold items.

    • In general, PHD including the recommended supplements is what we recommend for Raynaud’s and hypothyroidism. If you are hypothyroid you may benefit from hormone replacement. If you have associated infections then you may benefit from diagnosis and treatment. But it seems to cure itself if you tend to good health practices.

  18. An intriguing reference to prebiotic lipids (in almonds).
    ” finely ground almonds significantly increased the levels of certain beneficial gut bacteria. This effect was not seen when the fat content was removed from the almond preparation, suggesting that the beneficial bacteria use the almond lipid for growth, and this is the basis for the prebiotic effect of almonds.”
    This makes sense, as surely feeding bacteria on purified prebiotic fibre is like feeding humans on purified carbohydrate; man and microbe do not live by bread alone.

  19. It will be the first book I have ever ordered online…

  20. Paul,

    I am struggling with the issue of balancing all the positive nutritional benefits of cruciferous vegetables vs the negative effects of the goitrogens for someone with hypothyroidism. I have read everything I can find on the reduction in goitrogens from cooking, but they all focus on steaming or boiling. Can you comment on whether roasting at high temp (425 for 45 mins) has any effect? How about satueeing? Also are there some choices that are better than others? Broccoli or cauliflower? Spinach or kale? Brussel sprouts or cabbage?

    Thank you so much for the wonderful contributions you are making to help shed light on the truth about real nutrition and health. You have made a tremendous impact on our family and so many others.


  21. Hi Paul,

    I have two questions about making cocoa for the benefit of my arteries and blood pressure.

    I have read that any milk taken with the cocoa reduces the absorption of the flavanols. Is there any reason to believe that coconut milk would also reduce the benefits?

    I can’t wait for the new book. I just pre-ordered second copy to give as a gift

    Thanks for all you do.


    I do have blood sugar issues and cannot use a real sweetener. I have tried different varieties of stevia, but they do not work with plain cocoa….still too bitter. I found something in my cupboard — a bottle of sweetsfree from a few years ago. It is pure liquid sucralose. Just one drop was all I needed. Do you think there. Old be any harm in a drop a day?

  22. Oops. Can not get used to using my iPad

    I have big fingers! And things get rearranged without my consent.

    Sorry for the messy post.

  23. Oops. Can not get used to using my iPad

    I have big fingers! And things get unintentionally rearranged.

    Sorry for the messy post.

  24. Paul, I don’t know if you ever met Michio Kushi (one of the founders/pushers of macrobioitics n the US), but you share at least one obsession. Whenever you met him, he would grab your hand, stare at your face, give you the instant macrobiotic diagnostic analysis, and say. “Too much frour! Stop eating frour!”

    Of course, he insisted on gobs of brown rice at every meal…and chain smoking, but…

    • I used to be Macro. I brought my father with ALS to see Michio for a ‘cure’in 1975. He puffed his Winstons and I didn’t think much of him…but loved Osawa’s books. 60 to 80% carb diet. Too must gwain!

    • Haha now every time I see someone with a glistening/puckered face I’ll think “too much frour! Stop eating frour!” 🙂

  25. I mistakenly ordered rice flour from Amazon (meaning to order rice), and now I’m not sure what to do with it! I found a recipe for rice bread, and it was ok, but not great. What does one do with rice flour??

    • David,

      The real question is what does one not do with rice flour?! It is super versatile stuff. You can use it as thickening agent for gravies in place of regular flour, you can blend it with other things like potato starch and tapioca flour to make baked goods, you can make lots of Asian type dishes. Here is a link to my personal favorite: http://www.foodandwine.com/recipes/banh-cuon

      The possibilities are endless!

      Best of luck.

  26. David: I use rice flour to make the roux for gumbo & etouffee. I’ve seen it used for tempura as well as fried fish and chicken wings, but haven’t tried those yet.

    Lindsay: That recipe sounds fantastic! I may try a variation w/ ground beef.

  27. Paul,

    As I’ve mentioned in recent posts, I’m getting intravenous high-dose C and taking Valtrex to combat a chronic epstein-barr infection.

    Symptoms include sore throat, white-coated tongue, blepharitis, insomnia, brain fog, depression, high LDL. All other infectious tests have come back negative: stool, serum, tongue culture.

    Today I saw an ENT, who gave me a (nasal!)videostroboscopy to examine my vocal chords. He found the chords to be inflamed and a granuloma on the right chord. His diagnosis is GERD. As for the tongue-coating, which admittedly is mild, he thinks the culprit is GERD and that my high-dose coffee regimen is preventing dead cells from sloughing.

    I declined the purple pill. I also am not going to try Gaviscon antacid, an algae/bicarbonate mix that’s apparently first-line therapy in the UK.
    I also, sadly, am going to forego coffee for a while.

    Is there anything else I might try diet or GERD related? Frankly it’s surprising given that I have a clean Metametrix test and no gut symptoms. Would bentonite clay be advisable? Betaine HCL?

  28. Hi Paul & co,

    I read Perfect Health a couple of months ago and have been applying a lot of the information to recover from some brain issues I’ve suffered starting 5 months ago. Previously I was paleo and low carb before that pretty religiously – about 5 years back, and have been in great health.

    Starting 5 months ago, from a vacation in Thailand, I fell ill and started getting headaches, lethargy (sleeping a lot) and weekly phases of a few hours of ‘altered state of consciousness’ (feeling like pressure in head sometimes). In the last 3 months I have also had increased symptoms of neuropathy. Starting with weakness of limbs, or slight clumsyness I noticed, then in the last few weeks shaking of hands and legs. Since this started I’ve also had a small lump behind my ear. I often get dull pain on left side of head just hanging there, not like a headache.

    I’ve seen countless doctors and neurologists and was told that with time my symptoms will get better (MRI, CTScan and blood labs all negative). I’ve had MetaMetrix GI Effects done and it came back positive for unknown Parasite or Protozoa and Blastocystis Hominis. A doctor’s data urine toxicity analysis came back slightly high on Caesium and Thallium (no provocation used). My white blood cell count was just below normal reference range for first 4 months, then had jumped up into mid-normal range 1 month ago at last check.

    I have a few questions:
    1. Do you think this could be a ‘brain infection’? Similar to the one Paul spoke about in the book.
    2. In the last couple of weeks I have been taking chinese herbs (given by a traditional chinese doctor and cat’s claw) – this may coincide with my recent heightened symptoms (shaking all day) – could this be a ‘die off’ reaction with release of toxins as I’ve seen Paul mention above? How to test for this?
    3. Do you think acupuncture / electroacupuncture could be helpful (suggested by chinese doctor)?
    4. If you have any ideas I’d love to hear them of course.

    Thanks for all your great work here. It’s an amazing resource.

    • Damien, can you list the chinese herbs, or if not the name of the formula?
      Have you had your ears (esp left) checked by MD?
      A “die off” reaction should include nasal stuffiness, nausea, depression and maybe rash.

      • Hi George,

        Thanks for your reply. This all started with a visit to an ENT about the lump behind my ear around 5 months ago – then I got brain symptoms and moved over to neurology and haven’t seen one since.

        The Chinese herbal mix contains these (and a couple of others I’m not sure about):
        Pinellia Tuber
        Rhizome of Largehead Atractylodes, Falcate Micromelum
        White Paeony Root
        Paeonia sterniana Fletcher in Journ
        Salvia miltiorrhiza
        Radix Puerariae(?);kudzuvine root
        Figwort Root

        For ‘die off’ while there is some nasal stuffiness, couple of bouts of nausea and have been feeling more down – I don’t think these symptoms are strong.

        • This is an anti-inflammatory formula – I will check the details more when I’ve a faster computer. Atractolydes is also anifungal; kudzu is soy isoflavones. No obvious issues from the 7 herbs I know, I’ll check the rest, but die off does seem possible (i.e. it might just be working). Drinking extra water, might help.

          • Scolopendra is centipede,
            falcate and pinella are brain tonics/protectors,
            thorowax is bupleurum
            pueraria is full of phytoestrogens (like the kudzu, but different ones – sterols)
            Figwort is a blood purifier.
            Nothing here so far that is on any “danger” list; not something I’d want to take long-term, though; hopefully a short course will be effective.
            Of the related bupleurum formulas, wikipedia says
            “This formula should not be taken without a prescription from a licensed practitioner of traditional Chinese medicine and should not be taken for prolonged periods of time and could cause headache, dizziness and bleeding of the gums. Chaihu might slightly reduce white blood count.”

    • Hi Damien,

      I don’t know, but it’s not uncommon to pick up infections when traveling in the tropics.

      You can test whether it’s toxins by seeing if detox aids like clay, charcoal, salt, and water reduce symptoms.

      No idea about acupuncture.

  29. Hi Paul,

    I sent you a message last week and I see that you did reply but for some reason my server filtered the message and I could not retrieve it. I did logon to the site but could not find the reply there either. Could you please just reply again, would really appreciate it.

    Have been overweight since I was 5. (My mom had PCOS so I think I had hormone trouble from an early age) Been dieting since I was 11. Tried all the diets. In grade 10 I decided enough is enough, I would get thin or die. I followed my own diet and only ate once a week (Sunday lunch) I lost tons of weight but I think that is where I did damage to my body. When I reverted to eating normally again I gained the weight back. Have not been able to lose weight since then. More than the weight it was the health issues that were worrying me. At the time most of the health issues started I was only eating 800 calories a day. Some meat and veg, NO carb, No fat.

    Symptoms were:
    Hair falling out, high insulin, no periods, low vit D, low vit B, severe stomach ache just below my ribs on the right side, heart palpitations, severe fatigue, constant bone pain, constant ringing in my ears and constantly felt starving.
    I went to see an endocrinologist. After doing bloods she said my biggest problem is that my insulin is very high. She said I must take 2000mg of glucophage per day and cut our all carbs. When I told her I don’t have carbs she said I must stop eating certain veg like carrots etc and only eat the green veg.

    My symptoms got progressively worse. The pain in my stomach got so bad that I thought I had cancer. My GP recommended I stop the glucophage which I did and it help a little with the pain in my side. I then found your site and have been following the PHD for a couple of months. The changes are amazing. I’m starting to feel human again. The pain on my side in completely gone. (Thanks so much). I am however still struggling with some issues as follows: Insulin still high, cholesterol has gone up slightly since I have started the PHD, ringing in my ears, low vit d, b,. My vit D seems to be getting lower even though I get sun and take D supplements. The doctor does not know what to do anymore. Dry flakey skin, bone pain, fatigue but the worst is that I seem to be getting food intolerances. And it’s not always the same thing. When I eat sometimes my chest closes up and I start coughing up mucus and from just below my chin to my collar bones my skin goes red and start s to itch. And it’s not the same foods. Sometimes I can eat a strawberry and I’m fine tomorrow I react to it. The other day I had rice and beef and I reacted to that. Then the next day I don’t. this seems to be getting worse. I’m afraid to eat something.

    Please help.

    • hopefully you just used the ctrl+f function to search for the answer he gave you on the phd website (not in your email)

    • Hi Joia, I have learned from Dr. Bob Marshall that maybe your vitamin D is not coming up because your gallbladder might be jam and it could be jam because of a Vitamin B6 deficiency. Here he explain’s it himself


      hope it helps and if you try let me know if it works


    • Hi Joia,

      I left a reply here: http://perfecthealthdiet.com/reader-results/comment-page-2/#comment-93437. The next most recent comment of yours was here: http://perfecthealthdiet.com/q-a/comment-page-28/#comment-85459.

      Let me start by saying that I’m very happy you are feeling better. Also, what I said in the first reply linked above could be repeated here.

      Surely you were terribly malnourished through the period when you weren’t eating. It’s common to have intracellular infections flare up during a refeeding period after famine or starvation, as immune defenses such as autophagy are suppressed as long as cells are rebuilding themselves.

      If insulin is very high despite not eating carbs, you may have an insulinoma. I do not think the advice to avoid carbs is sound. What does your blood glucose do? Are you hypoglycemic? Do you become hyperglycemic if you eat carbs?

      I’m guessing your serum cholesterol is low, but you haven’t given numbers. I discussed vitamin D in the other reply.

      I think you have to try to be well nourished despite the difficulties with food, to support immune function with intermittent fasting (daily 16-18 hours fasting, 6-8 hours eating) and circadian rhythm strategies (daytime exercise and sunlight, night-time dim lights and sound sleep), and to try to diagnose any infections and endocrine disorders.

      They should also do standard diagnoses for causes of your endocrine issues, here is a page discussing how insulinomas are addressed: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001424/.

      This is a case for a good doctor. I hope you will keep us posted on how things go.

  30. Can anyone who has taken the Metametrix GI Effects stool test comment on whether it tests for a leaky gut? This description


    says that the test measures (among other things) markers of digestion and absorption, but I am not sure if that is the same thing as leaky gut.

  31. Paul and Shou-Ching,

    I am rereading you book as I axiously await the new edition and I found the discussion of toxins and Hormisis interesting. My question is this:

    Would you consider it a good prcatice to occasionally (say once a month) ingest a small amount of a toxic food to prevent becoming totally intolerant of it similar to the story of Mithridates VI you relate in your book.

    I am wondering how I should handle the occasion when I am a dinner guest and pasta is the only thing on the menu. Of course I could just not eat, but if it is, say my new boss, that might be uncomfortable.

    I read on another blog of someone who became super sensitized to peanuts when he stopped eating them and now makes it a practice to purposed eat one or two several times a year to prevent a reaction from inadvertant consumption.

    I would love to hear your thoughts on this.

    • Hi Carolyn,

      We eat wheat occasionally while traveling or in social environments where refusing it would be impolite. It happens 3-4 times a year. I don’t think it is likely to do any harm unless you have celiac. “The dose makes the poison.”

      Immune desensitization is an interesting idea. I’m not sure when that would be a good idea, I am not that knowledgeable about immunology.

  32. Paul and Shou-Ching,

    I stumbled upon an article that you guys may have posted about already, if so I apologize. But it basically talks about a study involving high fat during pregnancy can cause the thyroid axis to align differently, potentially leading to hypothyroidism later in life.

    Here is a link to a synopsis of the article.


    It seems like this is referring to a different issue than low-carb during pregnancy, but I would love to hear your interpretation of the data.


    • Hi Andy,

      I’ve downloaded the paper. It’s a bit difficult to interpret.

      The monkeys on the high-fat diet get only a little more fat (18% of energy), but their diet was “supplemented with calorically dense treats” — presumably candy and junk food. This succeeded in making the monkeys fat — HFD monkeys weighed 10% to 30% more than control monkeys. They don’t give the composition of the high-fat diet but it’s probably high in PUFA because it induces fatty liver disease (http://www.fasebj.org/content/early/2012/09/13/fj.12-212878.abstract).

      Basically what they found is that obesity in monkeys is associated with high T3 and low T4, and that this pattern which appeared in the obese mothers was replicated in their fetuses.

      This is not surprising since the fetuses are exposed to the same dietary and hormonal environment as the mothers while they remain in the uterus.

      The paper only describes events up to the third trimester. They tell us nothing about the outcomes of the babies after birth.

      All in all it is hard to interpret other than that a diet that makes you obese is probably not good for you.

      • Sorry I hadn’t read your comment yet.

        Thanks so much for your quick response. I appreciate your dedication to science and informing people. You guys are awesome!

    • I also purchased a copy of the article itself (whereas the link is to an overview of it). If you email me personally I can send a copy of the article. I am not sure the legalities of that, but if it is ok I don’t mind sending it.


  33. What specific things should I be doing for severe headaches? I like pPHD because I can eliminate things if I get to have potatoes. I get a debilitating headache about once a week. The least amount of stress excitement over exertion seems to bring one on.


    • Hi Susan,

      Well, headaches are something you have to experiment with. Some people find that magnesium helps. Sometimes ketogenic dieting helps — see our migraine/headache category for success stories. Sometimes eliminating food sensitivities or toxins works. The best thing is to follow good general health practices first and then experiment with a few variations.

    • Susan, I used to suffer from frequent headaches, particularly when I got stressed. I actually highly recommend finding a good chiropractor who knows Active Release Technique…it is very often related to knots and tension in your traps/upper shoulders. I know where to massage myself now but one visit used to relieve me for a few months.

    • Susan, you can also take a look at what Chris Kresser says about migraines here: http://chriskresser.com/coq10-vaccination-and-natural-treatment-for-migraines (search for “3 foods”).

      Basically you can try avoiding histamine, tyramine and arginine in foods and see if that makes a difference.

  34. Hello Paul,

    I was taken aback by a doctor visit today. I am taking Armour and unithroid. Recently, a doctor who isn’t used to working with it raised my Armour from 60 to 90 mg to treat a low total t3, it was 62 (92-178). After 6 weeks on the same unithroid and increased Armour, my Total t3 is only 65.

    Well he brought another doctor into the conversation and they argued, and now I am really confused. One said increase the unithroid and back the Armour to 30 mg and the other wanted to just take me off the unithroid an put me on 120 mg of Armour. I have been have heart palpitations, but I don’t know if its the Armour or not. My TSH went from 1.78 to .05.

    I keep to the PHD as much as possible, but I definitely give into the occasional wheat product. I think you have said selenium and/or iodine can effect T4 conversion.

    Honestly, I am tired, I don’t sleep great and I get racing heart at nights when I sleep. Those sound like thyroid issues. But I left the office today…no I ran from the office wondering if either of them knew the heck what they were talking about. I would love some reliable info I could present to them since they seemed clueless.

    Thanks for your time.,

    • Hi Amy,

      I’m afraid I don’t have the clinical expertise to know how to interpret responses to different thyroid hormone formulations. However, here’s my two cents: Since your body is regulating T3 levels to 62-65, suggesting that it might remain there even on low T3, and with TSH so low, my sympathies are with the doctor who wants to reduce Armour.

      I would try to listen to symptoms, try natural healing methods including circadian rhythm strategies, and minimize doses of hormone.

  35. Hi Paul,

    I read over a Chris Kressers website that mentioned a trial study of people suffering from chronic constipation were given Melatonin with a very high rate of relief (100% of them reported relief after 40 days).

    Do you have any tips on creating ore Melatonin naturally apart from avoiding light sources after sundown and sleeping in a very dark room?


    • Hi Kris,

      Any circadian rhythm enhancing strategy should help. That includes daytime exercise, sunlight and daytime bright light exposure, dim lights at night, intermittent fasting with the feeding period concluding around sunset, social engagement (faces therapy, voices) during the day, plenty of time for sleep and natural waking.

      • here are a couple of other little circadian rhythm enhancing strategies that i think help me personally;
        1. using f.lux on my computer

        2. changing my computer desktop background;
        In the morning i change in to a nice bright picture of the sun rising over the ocean.
        As the sunsets, i change it to a plain & boring dark background. the one i use is a dark brown sky (the dark brown seems be easier on the eyes than black).
        Sounds minor, but it does seem to have a definite effect on me.
        ie. the dark brown sky background definitely feels unpleasant to look at during the day to me, but at night it feels good.
        & when i flip to the sunrise background in the morning i seem to instantly feel good/brighter & clears any sleepy feelings.
        & on the other hand the sunrise background at night just feels wrong, “does not compute”, plus its too bright.

      • feeding period concluding around sunset

        Paul, does this mean changing the last meal of the day based on seasons? As an example, depending on where a person lives, sunset can be 4:30 PM during winter and 9:00 PM during summer.

        Jun sunrise 5:26 AM, sunset 9:03 PM, day light 15h 36m 54s
        Dec sunrise 7:49 AM, sunset 4:35 PM, day light 8h 46m 14s

        Also, I typically sleep/wake at about the same times year round. Should these be changed based on seasons and not go to sleep at say 10:00 PM all year round? Should we eat less, sleep more, and be less active during winter when day light is less?


        • Hi Mark,

          Well, I wouldn’t vary too much based on season. If you did that and lived at the poles, you’d have a 24 hour feeding window at the polar summer and a 1 minute feeding window in polar winter.

          In the tropics, of course, there’s very little seasonal variation in sunset time. Most human evolution was probably within 20-30 degrees of the equator.

          Same with sleep. A little discordance of sunlight cycles with our circadian rhythms is the price we pay for living at northern latitudes.

  36. Also, Paul, while working on improving gut health through diet, what’s the best way to come off using laxatives in your opinion?

  37. Hi again Paul,
    You mention charcoal fairly often.
    I was wondering if charcoal is okay to use (ie. may be beneficial & does no harm) in generally healthy people.
    For instance taken before bed (on an empty stomach) & away from other supplements.

    • Hi Darrin,

      It will take away nutrients, bile, cholesterol, and some other things that you might like to have, and may disturb the gut flora a bit.

      It is an effective aid for excreting toxins though.

      I wouldn’t take it unless you have some reason to suspect circulating fat-soluble toxins.

  38. Hello Paul

    I finally got hold of diflucan 150mg – 20 pills. I have seborrheic dermatitis and it improved significantly with diet change to PHD but its not improving anymore. I used to be constipated but PHD cured that too. However my digestion is still not optimal and I have low stomach acid but I’m supplementing with Betaine HCL. So how do you recommend I take the diflucan? One a day? with meal or empty stomach?


  39. I have been on the paleo diet since June 2012 and following it very strictly. Up until 6 weeks ago my lipid panel was a mixed bag

    Total cholestrol was up to 290 (creeping up from 220 in June)
    HDL was 57
    LDL was 197 ( LDL was 150 before I started with the Paleo diet)
    TRIGLYCERIDES: 77 (DOWN FROM 150 before paleo)

    I was mostly concerned with LDL going up and 6 weeks ago followed up your advice and started to increase my carb intake to 300 calories per day mostly from white rice and yams.

    A week ago I did another blood test and my lipid panel results were:

    Total : 250
    HDL: 63
    LDL: 152
    TRIGS: 173

    so now I am puzzled by why the TRIG number shot up? I was pretty close to 65 grams of carbs per day, it seems to lower my LDL number and Total Cholestrol. My ratios are fine but I thought that low carb intake was the main reason for lowering TRIGLYCERIDES. i ONLY INCREASED MY CARB CONSUMPTION by 40 grams a day, any thoughts of why the Trig number has shot up so high?

    • Hi Yoram,

      The most likely cause of your high trigs is a choline deficiency. See http://perfecthealthdiet.com/2010/11/dangers-of-a-zero-carb-diet-ii-micronutrient-deficiencies/. To fix that, eat at least 3 egg yolks a day — maybe 5 or 6 for a while — plus 1/4 lb beef liver per week plus maybe some chicken liver.

      I would also check on thyroid status (hypothyroidism can raise trigs), and tend to nutritional status by taking our recommended supplements.

      I think you could also increase carbs a bit further, to the 100-150 g/day range. You might also look into getting more of your fats from food, less from oil — you want more dietary phospholipids and fewer triglycerides.

      Best, Paul

      • You might also look into getting more of your fats from food, less from oil — you want more dietary phospholipids and fewer triglycerides.

        Interesting, I’m in the middle of trying this now. My trigs are normally low, but did increase (as well as LDL) from 32 to 79 changing from CW lower fat (25%) healthy diet to PHD 20/30/50% P/C/F, which included about 2T coconut oil, 1T ghee. I thought the trig increase was odd, albeit still good, because I was eating fewer carbs.

      • thanks Paul. A couple more questions in regards to your answer:
        1. Choline deficiency I have been taking a multivitamin from Dr. Mercola and saw that it has 60mg of choline per day. I also noticed that copper is only 50mcg per day so definitely low dose here. In addition I noticed the ratio between Vitamin A to Vitamin D3 is 1:1 5,000IU per day for both (I am not sure if this is a problem) but probably copper is a problem
        2. Thyroid past tests I had TSH at 1.4 and T3, T4 middle of the range. Strangely enough last test from 2 weeks ago TSH creeped up to 2.2 and T3,T4 still middle of the range.
        3. increasing carbs is fine but if my goal is to lose weight this might be a problem? In terms of carbs consumption per day in your book you talk about safe starches 300 calories per day, does it include also fruit consumption, shall I count fruit separately?
        4. If I was to get more fat from foods this will mean that I need to increase my protein intake, I thought in your book you were recommending to limit the protein intake to 15% of our daily diet? so how do I do that?

        • Hi Yoram,

          60 mg is not much choline, try for 600 mg/day.

          Increasing carbs from such a low level usually doesn’t inhibit weight loss. Fruit counts as a carb source but fruits are sugary rather than starchy.

          Bone marrow would be a good fat source with little protein. But I think egg yolks are probably the easiest solution (high in choline, low in protein).

          • thanks.

            I eat every morning 2 whole hard boiled eggs so probably I can increase this to 3 a day. How much choline one gets from egg yolk?

            In terms of fat is it also possible to eat more avocado or macademia nuts instead of oils? never used bone marrow before any ideas how you cook it or use it on a daily basis, how much fat calories can one get out of it?

          • Hi Yoram,

            Roughly 120 mg choline per egg yolk.

  40. Thanks to you both for your commitment and investment in our collective health.

    2 years ago, I was a family physician dwelling in mainstream ignorance and bliss. I was conscientious – but there was much I had never contemplated.

    Then at age of 46, I had a surprise heart attack. Soft plaque rupture. Holy health crisis, batman! THe bad news accumulated – high Lp(a), PCOS, insulin resistance, obesity, psoriasis. Wow – the cards were stacked against me.

    I took it all on – low carb, gluten and grain elimination, Whole 30, exercise, sleep. Vit D and Mg supplementation, thyroid monitoring.

    More recently, I had my ApoE genotyping done. Quite devastated to receive the news of ApoE 4/4. I feel quite paralyzed. Do I do low fat or high fat? Should I do statins after all – or is that going to toast my brain?

    My next plan is Metametrix testing incl organic acids. My constipation, fatigue and worsening psoriasis tells me there is room to improve for my gut. Not sure what else to think about…biggest issue relates to diet and saturated fats…

    Any thoughts gratefully received….

    • Hi Cathy,

      ApoE e4 is the ancestral allele and it should be fine with a Paleo diet. I wouldn’t worry so much about that one. Each allele type has benefits as well as risks.

      Personally I wouldn’t do statins.

      I would focus on healthy dieting along the lines of our food plate, and circadian rhythm strategies which look more important every time I look into them. Our new book, out in December, has an extensive discussion of them. Exercise and sunlight exposure are both crucial. Listen to your body, over-exercising can be as bad as not doing it.

      I think diagnostic testing such as Metametrix is under-performed, perhaps because physicians don’t know what to do with the results. It can’t hurt to gain insight.

      Best wishes and keep us posted!


      • ApoE e4 is the ancestral allele and it should be fine with a Paleo diet.

        Makes sense, although I’ve begun to wonder if it depends on which Paleo diet variant and should it be one that has less concentrated oil sources. For example, eating whole food coconut seems much different than eating coconut oil. Maybe concentrated oil sources are less ancestral.

    • Cathy, hi,
      I am a chiropractic physician with 34 years in nutrition, lab testing and classical homeopathy. If you want to work by phone I’d be glad to help.

  41. Hi Paul, I have looked through your section on Constipation, as I have had a noticeable change in bowel habits recently.

    I saw where you reference high levels of Vitamin D supplementation as a possible factor. So happens that my doctor recently put me on 6000IU/day VitD3 to raise my serum D3 levels.

    As an experiment, I stopped all VitD3 supplementation for several days. My regularity and stool quality gradually improved, to the point where they are pretty much normalized at this time. So I concluded that the VitD supplementation was a major factor in my constipation.

    Two questions: 1) Can you elaborate a bit more about the biomechanics involved in how Vitamin D precipitating changes in bowel function? 2) I still need to supplement VitD3, what would be your opinion of a dosage that would not interfere with normal bowel function?

    Thanks, you are doing truly great work here. I doubt that I would have found the VitD-constipation connection anywhere else.

  42. Hi, Paul.

    There has been much written on high blood pressure, but not much at all that I can find about low blood pressure. In my case, my blood pressure is still very low despite following the PHD protocol for over a year. Perhaps in the updated book you’ve included recommendations for this issue?

    Female, 5.7, 125lbs. I am energetic and walk several miles a day with occasional HIIT. I eat between 9 and 5, following the PHD ratios and foods: eggs, broth, potato, organ meat, fish, butter. D3, vitamin k2, magnesium. I cannot remember the last time I felt hunger.

    Thanks for any recommendations for increasing circulation(?) and blood pressure.

    • Hi Maria,

      You didn’t tell me what your blood pressure is. Do you get dizzy or faint when you stand up?

      I would focus to start with on electrolytes (salt, potassium [eg tomatoes, potatoes, bananas], magnesium, calcium [eg bone broth]) and water.

      • Always been around 100/55. As a kid I fainted all the time. Nowadays (in my 30s) I feel great most of the time. Occasionally the “head rush” first thing in the morning, or after sitting for awhile. Been trying to stand more, 🙂

        NOw that you mention it, with zero processed foods, and <100 carbs, I am likely not getting enough salt, so will see if that helps some.

        Thank you so much. I'm planning to give your book to friends and family at Christmas, as it's made SUCH a difference in my health so far.

  43. Hi there! Just wondering what you think of this meal replacement shake? I am looking for something quick and easy for breakfast or lunch. Could someone please check it out and give me some feedback

    • Hi Arlenena,

      I’m not thrilled with meal replacement shakes. How about whole fat yogurt and berries? We also boil a dozen eggs and then it’s easy to take 2 plus a banana in the morning.

  44. I’m no expert, but I wouldn’t drink that it has soy in it.

  45. What is your opinion on the Dr Fuhrman Nutritarian Diet? Here is the overview:

    1# raw veggies
    1# cooked veggies
    4 fruits
    1c legumes
    1oz nuts/seeds (or more if active)
    1TB chia or flax
    1c starches (starchy veg or grains, GF preferred)
    1/2-1/4 avo, optional
    12oz animal protein per week, optional

    It has a ton of science behind it and is promoted to be a disease-reversing, health-promoting, longevity-promoting eating style, loaded with antioxidants, vit/min, etc. I’d love your thoughts

  46. Hi guys,

    Quick feedback. I asked a previous question regarding GI upset after taking tablespoon doses of coconut oil. I found Vitamin C/Taurine supplementation to be of no benefit, but it helped when I held the coconut oil in my mouth and ‘chewed’ it for about 2 minutes each tablespoon. Gross, but it works.

    New question. I am prone to getting warts on my hands and feet… Most doctors have told me that the body has a tough time fighting these viruses due to their location on the skin. Any advice for resolving this?

  47. Hi Paul,

    What do you recommend for someone wanting to come off laxative dependency for constipation?

    What steps would a person need to take to restore their normal gut peristalsis which has learned to become inactive by depending on a stimulant to eliminate stools?

    Thanks Paul

  48. Paul, why do allergies/asthma seem to only plague modern civilization? I know you don’t agree with the hygiene hypothesis(you changed my opinion on this as well) but I’m not aware of an alternative hypothesis that you or anyone else has developed. Are you familiar with the recent study that showed that Amish children in Indiana had vastly less incidences of allergic symptoms than the general population? The two hypothetical reasons that were stated was exposure to farm animals at a young age and consumption of raw dairy?
    Its probably unscientific of me but I’m going to jump to conclusions and start consuming significant ammounts of raw kefir.

    I’d love to hear your thoughts on the study and allergies in the West dr jaminet.

    • Hi Jonathan,

      Although I don’t think we are sick because our environment is too clean (it’s not so clean that probiotic microbes can’t flourish in and on people and transmit from person to person, or from food to person), I do think that disturbed gut flora, skin flora, and respiratory tract flora are a factor in modern diseases, and that these may be more common due to the invention of antibiotics and other factors such as freezing/refrigeration of food, the decline in fermenting/pickling, and the use of preservatives in food

      I also think there are many new aspects to our diet (omega-6 fats from seed oils, refined sugar, prenatal vitamins, food fortification, water purification removing minerals, etc) which impact our health and especially may have effects on fetal development during pregnancy.

      Also our new work environment, with sedentary office work and loss of sun exposure, disrupts circadian rhythms and immunity.

      So there are many causes of disease which have become more salient in the last sixty years, and it is no surprise that certain diseases in which those causes figure may have become more common.

      It’s still hard to disentangle precisely which factors figure in which diseases.

    • As an n=1 experiment I am treating my hay fever by drinking well water (from a mountain stream and full of saprophytic bacteria) at least twice a day. And it’s working very well- I have sneezed exactly 3 times in the last 2 weeks. I’ve drunk the water before off and on but this time I’m trying for constant gut exposure to the bacteria and watching my symptoms.
      Asthma is more complex because omega-3 and glutathione are important nutritional factors (which makes seed oils and acetaminophen possible causal factors).
      The hygiene hypothesis as it is today involves some specific parasites priming the immune system at particular points in its development (where they used to appear in our evolutionary history). Trying to alter this later is like trying to undevelop a photograph. It just can’t be done, but you might be able to paint over it reasonably well sometimes if you knew what to use.

      The epidemiology behind the modern hygiene hypothesis is far stronger than that used in most dietary arguments. The odds ratios can be factors of 10. It’s a rapidly growing science and the mechanisms, though very complicated (immunology will soon become a job option for computer programmers) are being tabulated.

  49. What are your thoughts on bottled kombucha for fermented foods?

  50. Make sure there is not to much sugar some of the Kombucha are loaded with sugar.

Leave a Comment

NOTE - You can use these HTML tags and attributes:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

This site uses Akismet to reduce spam. Learn how your comment data is processed.