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. Thank you so much Paul! I really want to get over the top on this thing!

    What kind of blood or stool tests should I ask my doctor to run? What do I do about the advil? Any thoughts?

    Make it a great day,


  2. Hi Scott,

    The best stool test I know of is the Metametrix GI Effects DNA test for about 40 common pathogens. It’s a bit expensive and it may fail to find the cause of your RA, but has the potential to provide great insight if your doctor is willing to order it.

    Blood tests – these are mostly serological tests looking for antibodies to potential arthritis-causing pathogens like Mycoplasma, Borrelia, or Chlamydophila pneumoniae. Unfortunately, the antibody tests are not reliable, you can be positive without a current infection and negative with a severe infection. It’s probably not even worth doing. I would just try antibiotics, see if they help.

    Advil – you be the judge. It’s bad for your gut. It may be bad for your immunity. But symptomatic relief is important. Try to wean yourself off it. Antibiotics may help.

  3. Thanks Paul, I will cut the iodine by 3/4 and restart there, and thanks for the info on the Epley maneuver. I have not started it yet as currently the vertigo is only minor. I suppose I should give it a try and if it works I suppose i will know the vertigo does indeed involve the “ear rocks”.

    Thanks Sweet Feather, for the info on POTS. I looked it over but not too much of it seems to fit with anything i experience lately. I’ve been hooked up to the 24 -hour heart monitor in the past, but ever since cutting out processed foods all my heart palpitations (unless thyroid med dose is too high)
    as well as a host of other issues has disapperared.

    If you go with the MCT oil, start slow with small amounts…. Me and my family used extra cocnut oil in our diet for awhile, then switched to MCT oil, but the MCT oil oftens gives us stomach cramps/aches if we use too much. I still cant tolerate a full tablespoon at a time.

  4. Thanks, Paul! Started this antibiotics this morning. Not taking the omepradex. This is the course of action I was thinking of doing.

  5. Hi Paul,
    I read Shelley and Sweet Feather’s comments on POTS and it reminded me of a question I had about my own POTS, which I no longer have.

    I suffered from mild POTS for decades along with CFS. They seemed to get fluctuate in intensity independent of one another. A year or two ago, I suddenly realised that the POTS was totally gone and had been for a long time. I wracked my brain to think what would make the difference. The only change I made around the time it disappeared was ditching the industrial oils (switched from soy to olive oil). I made this change two years before I cleaned up my diet in general, so it really was the one big dietary change.

    On the other hand, it may have just resolved by itself. Any physiological reason to believe that soybean oil could be implicated in POTS?


  6. Hi Ruth,

    POTS is a rather mysterious condition. We have some experience with it because a nephew, for whom we’ve been guardians for 6 years, has it.

    He used to have a standing pulse of 120 (reclining 60). When we put him on our diet, it went down to 95. Unfortunately, while he’ll eat our food, we could never get him to take supplements, so he didn’t wholly implement our program. Then we learned that parasitic infections can cause POTS, and gave him a course of mebendazole. That lowered his standing pulse to about 80. Maybe we should do another course. However, he’s off to college, and eating pizza with his friends, and who knows what will happen.

    I don’t know what role soybean oil may have, other than that it’s an unhealthy oil and is likely to contribute to any disorder!

    Best, Paul

  7. Hey Paul,

    First, love the Q&A. I’ve learned a ton from reading these, and from other things in the book and site. Excellent.

    Okay, my specific questions. I’ve been reading a bunch about the role of iodine in immune system function. A Dr David Derry (you can read some of his ideas at http://thyroid.about.com/od/drdavidderry/Dr_David_Derry_Answers_Reader_Questions.htm) has some intriguing ideas about iodine and its function in the immune system.

    I think it is safe to assume on my part that I have a cpn infection. I won’t bore you with the details, but CFS, Fibromyalgia, etc. You know the drill. I also have horrible IBS and dysbiosis, and the only thing that has worked as been the Specific Carb Diet, modified to be very low carb and as close to PHD as possible. I can’t eat starches, though, as they bloat me up like a balloon.

    So, I’m wondering about iodine and cpn and IBS. First question:

    1. Would high dose iodine potentially be a treatment for cpn? Dr Derry has interesting anecdotal evidence, plus some biochemistry, to indicate that if iodine is beyond the level of saturation of the thyroid that it then can serve other functions in the body, particularly in an almost bacteriocidal way. I’m guessing that doses need to get into the 12 mg/day range, maybe higher. Your thoughts?

    2. Have you heard of any problems taking high dose iodine? I’m moving to 3 mg today, up from 1.5 mg, and I’ve been doing the doubling per month plan you advocate. I think I started at 1 mg with no problems at all, and did that for a few months, then 1.5-2 mg for a few months. I don’t see any downside to doing this, but then again, Dr Davis at Heart Scan Blog warns against high dose. I’m guessing that the cases he sites of using 6 mg/day were people who didn’t slowly double. I’ve had zero issues in almost 5 months of using 1.5-2 mg per day.

    3. Is there an upper limit to iodine? I know you suggest going to 12 mg, but I’ve seen numerous people doing much higher, at least temporarily.

    Thanks!…. Tom

  8. Second topic: modifying PHD to be Specific Carb Diet friendly.

    When I eat rice, potatoes, etc, PHD friendly starches, I bloat like a balloon. I should add I’ve been gluten free for 2 years, and eating low carb then very low carb for that time. I consulted Dr Davis last year, and he encouraged me to keep carbs below 50 g per day due to elevated LDL and small/dense LDL.

    A naturpath clued me into the SCD diet, and it eliminated the bloat. However, eating less than 50 g per day of simple sugars like juices, SCD yogurt (yogurt fermented for 24 hours to eliminate all lactose), sucks. I was MUCH happier eating 70-100 g carbs via rice and potatoes, at least in terms of not feeling “flu-like” and spacey all the time. My gut was bloated and uncomfortable, but I felt better. I also had less energy with 70-100 g carbs, but I had better mental state.

    Anyway, trying to reconcile SCD, PHD and Dr Davis’ advice of VLC has been a chore. Not to mention, I miss sushi!! 🙂

    Any thoughts? How to eat some starch and get bloating to go away?

    By the way, I’m about 100% certain I have hypothyroid, similar to the interesting post you did with Gregory Baron. Elevated LDL on low carb, no energy, low body temp, and a host of others. I’m seeing a doctor next month who does bio-identical hormones, so we shall see if thyroid isn’t an issue. I’m certain it is.

    Thanks again!!… Tom

  9. That is interesting about POTS and parasitic infection. I have had POTS since 2008/2009. My standing pulse when I first get up in the morning is anywhere from 150 to 170. Part of it is due to low cortisol but not all of it. Incidentally I was also just diagnosed with Lyme’s disease and Babesia. I am thinking those two alone could be the cause of POTS. I have been on a Paleo diet since 2003 yet I still got sick. I don’t eat grains, sugar of any kind, vegetable oils, etc.

  10. Hi Paul, Tom,
    I was thinking that maybe an idea for an SCD friendly carb for PHD’ers is coconut water? Like Tom I have problems with starches but so far no problems with coconut water. I often add some probiotics to it and then keep it outside the fridge to ferment a bit.
    Best, Claire

  11. Hi Paul, Scott Again. I’m having flu like symptoms, peeing all night, constipated and the feeling of anxiety(mind wont shut down) After the first night of the diet I urinated 8 times.(a lot came out) I started your supplements yesterday and quit Advil. I have not had any in 48hrs. So I stopped Advil, coffee (coffee is hard on my stomach) Wheat and sugar. Over night. I have not started the coconut oil yet but I will get that started today. I have had strep throat 8 times and mono twice.

    Thank you so much for your time,


  12. Hello, Drs,

    Thank you SO much for this amazing work you’ve posted to the public domain. I look forward to buying your book in support.

    Two queries:
    1. will you be attending the WAPF 2011 conference in Dallas?
    2. Will you post Bowel Disorders, Part V – or direct me to it?

    “Part V will deal with dietary tactics for defeating infections. These can be extremely helpful in overcoming any chronic infectious disease, and there is an undeniable infectious component to ulcerative colitis.”

    Many thanks,
    WAPF Chapter Leader in Calgary, Canada

  13. Paul,

    Just read your microwave post and wanted to make sure I am clear… I can microwave my sweet potatoes and purple yams and they will still have their antioxidant contents? (Although reduced)

  14. Thanks for the response back about the spotting. I think the causes of it, along with the cavities and fatigue, might be related to my low vitamin D levels and ongoing stress.

    What I was mostly wondering was why my cycle would be more intense when I did the paleo elimination diet last month (even when there weren’t that many changes). I suppose it could have been a coincidence. I will see what happens this month now that I am back to some raw dairy, potatoes, occasional rice. I am slightly higher carb and slightly lower fat (maybe 50% fat minimum, though)and lower protein, which I was doing pre-Whole 30. I think when I was on the Whole 30, it was more like 60% fat, 25% protein, 15% carbs (or even more fat than that, I think).

    I will make an effort to stay on top of nutrition. If I discover anything relevant, I will repost! I find the paleo information on women and children’s specific health concerns to be less developed, and I hope that changes for the future (or maybe I am just missing some important sources of information).

    Thanks for everything that you are doing!

  15. I just finished the book and am wondering where you get nutmeg butter? I did a search on your website and it didn’t come up with any reference, but you mention it several times in the book. Where do you buy taro? There were a couple other new-to-me starches I thought were mentioned but now I can’t find them in the book. Rice makes me “puffy” but I do ok with small amounts of sweet potato.
    The next edition of your book really needs an index. There’s lots of good information in the book, but it’s hard to go back and find it later without an index.

  16. Hi Paul,

    Back again with another question.

    I have been battling various health issues for a while and I thought I could figure out the answers myself but I’m getting increasingly frustrated.

    Basically I’m finding it impossible to eat healthily.

    Every time I try to stick to the PHD I start to get what feel like hypoglycaemic attacks. It happens any time I reduce my food intake or any time I have to not eat for more than 3 hours. The only way to avoid it is to constantly snack on high-carb high fat food.

    I have tried a low-fat high-carb version of the diet but I get the same result.

    The attack’s symptoms feel like hypoglycemia:

    Blurred vision
    Rapid heartbeat

    I just tested my blood sugar during an episode there and it was 120!

    It’s all fine as long as I am eating a lot (junkfood seems to work best!) but I have gained 15lb of the 60lb that I lost four years ago and I want to desperately buck the trend. But I can’t seem to stay on a diet for more than a day without getting these horrendous symptoms.

  17. Hi, Bought the book, read it twice, really enjoying it. Thanks so much.

    Curious to hear your thoughts on this report that I read as suggesting that rice might not be so clean.

    “RNAs from rice can survive digestion and make their way into mammalian tissues, where they change the expression of genes.”


    Thanks for taking the time.
    Randy Siler

  18. Hi again, I just went back to the link above and started reading the comments and YIKES–people are all over the place with their interpretations and not much of seems well considered. I’m hoping that I haven’t wasted everyone’s time asking this question.

  19. Are seeds OK in PHD?


  20. Hi,
    I have been following the primal blueprint for a few months and have recently come across the PHD. I have a few questions. I seem to be allergic/ very sensitive to salicylates which means I can only eat certain few vegetables. How can I get adequate range of vitamins if I can only eat six or so different types? With fish oil capsules are they all rancid, even ones clean from PCBs? Is it ok to have yoghurt every second day as I am not sure what occasionally means, does it mean once a week or month?
    Kind regards,

  21. Dear Paul, Just recently found your website, and I would like to present my case to you, seeking advice. I am 60 years old, 6’1.5″, 185+ pounds, BP 125/65 Pulse 60,in good health, except for the following: I have just entered my 12th week of constant headaches, with stiff neck that is begging to loosen-up some, having only 3-4 days headache-free since they began. This is not uncommon for me. Have suffered from Migraines since 1983 [32 yrs. old]. Have been to several drs. over the years with no good results. Extreme lethargy, lack of energy, at times unable to work. Can go to sleep, but have trouble waking. I farm in Mississippi Delta. Will sometimes fall asleep if still during the day. Sleep study revealed no sleep apnea. Loss of musculature. Foggy thinking, difficulty processing information, dizziness. Cannot tilt my head back, and look up without becoming dizzy, sometimes losing my balance and falling. Poor memory. Between the ages of 6 to 24 yrs. old, I sustained at least 20 concussions, being knocked un-conscious 15 times. At age 15 bit by venomous snake, going into anaphylactic shock as result of allergy to anti-venin shot. At age 23 diagnosed with encephalitis. I have had these bouts of headaches infrequently ever since. This almost always occurs in July or August, the same time of year the encephalitis was diganosed. These headaches are also similar to the headaches at that time. In fact, all the symptoms are, except now I have no fever. Most of these symptoms will fade when the headaches fade, but eventually they return, whether 1 year or 5 years later. But now they return more frequently. This is the second time this year, none in 2010, twice in 2009,spring and late summer, just as this year. I suspect two problems:1-Adrenal fatigue and/or low testosterone, and 2-chronic brain infection. No doctor has ever agreed with me on the latter, and only recently on the former. Am about to begin on Testosterone therapy. I apologize for the length, but really do not know where to turn. Hope you can help. Thank you for considering this. Bud T.

    Hi Bud,

    I certainly agree on the chronic brain infection. I have no opinion on the adrenals or testosterone. But those can be measured, so perhaps you should have them tested.

    Concussions, or any sort of brain trauma, are risk factors for brain infections because they breach the blood-brain barrier. The fact that you’ve had encephalitis is also a strong indication, since many pathogens that can cause acute infections can also establish chronic infections with less obvious symptoms.

    Headaches can indicate inflammation in the brain, which might be infectious in origin. A stiff neck is a common side effect of systemic infections. Fatigue and low energy, sleepiness during the day and difficulty sleeping at night, and foggy thinking are common symptoms of immune activity.

    So it’s probably an infection though some kind of allergy or toxin exposure (eg environmental mold) is also a possibility.

    The July or August pattern suggests that high vitamin D may trigger symptoms. Vitamin D modulates immunity and is antimicrobial. It could be that you get relatively high die-off and toxin production at that time.

    The trouble is your symptoms tell us there is high levels of immune activity but they don’t tell us why. Let’s suppose it’s an infection – the most likely explanation. The first problem is that we don’t know what kind of pathogen it may be. Is it worse or better on a very low-carb ketogenic diet? Eukaryotic pathogens like fungi and protozoa tend to flourish on ketogenic diets, but ketogenic diets are antibacterial and antiviral. Have you read our migraine posts discussing ketogenic dieting? Ketones can help relieve some other causes of headaches too.

    Other possible steps are experimenting with (a) detox aids like cholestyramine / bentonite clay / charcoal, (b) salt and water, or (c) antibiotics. The detox aids would help with environmental molds or fungal die-off toxins, or conceivably bacterial toxins admitted through a leaky gut. Salt can be antimicrobial, improve stomach acid and therefore inhibit SIBO, and improve kidney toxin removal. Antibiotics might show immediate effects against bacterial infections.

    I think you have a period of experimentation ahead of you, Bud. Are you on our diet and supplements? That is a good first step. You should try to be as healthy as possible, and relatively stable, before conducting other experiments, else they can be hard to interpret.

    Please keep me posted on how things go!

    Best, Paul

  22. Paul,

    Many thanks for your good advice. I want to let you know of a success story, and then follow up with a related question.

    I started PHD ten months ago after having previously pursued a low-carb paleo approach. At that time, I had a toe fungal infection which made the toenail of my right toe nearly black, plus it made my foot half-numb. It was getting so that I didn’t even like to go for long walks, which I have done all my life. After six months of PHD eating, some of the fungus had receded and some feeling had returned to my foot.

    Recently, after a discussion or two on your blog mentioned Epsom Salts, I added a nightly foot soak in Epsom Salts. It seemed to me that almost immediately there was a reduction in both the visibility of the fungus as well as a reduction in the numbness. As of today, most (but not all) of the feeling has returned to my right foot.

    Although I suspect the most recent improvement resulted from Epsom Salts, it might also be due to other changes which finally registered results. Those changes, in reverse order (most recent changes first): Nature’s Way Primadophilus, Yerba Prima Bentonite, intermittent fasting, recommended supplements, PHD nutrition.

    When you get around to writing your post on how to address fungal issues, I’d like to hear your thoughts on whether the existence of a fungal infection in the toes indicates there might also be one in the gut. My weight increased ten pounds after transitioning to the PHD, and although I’m getting close to a consistent 16/8 daily intermittent fast, there’s little or no downward weight trend. Which makes me wonder if some fungal bad guys might be lurking elsewhere to prevent weight loss. (And I know you have also promised a weight-loss post, and I’m looking forward to that one also.)

  23. Hi Paul and Shou-Ching,

    Firstly I’m a huge fan of your blog and love everything you do and that you take time to answer readers questions when you can.

    I know there is a lot of different information in the paleo world at the moment and exactly each expert is recommending, I am looking at putting together a sort of “day in the life of” many different paleo experts, such as Rob Wolf, Chris Kresser, Kurt Harris etc.. daily eating to show everyone the variety and how paleo can be individualised.

    I would be very great-full if you could contribute as I’m sure would the readers of it.

    I understand you are busy, so if you are unable to reply, I totally understand.

    Thanks Ollie

  24. Hi Paul,

    I was wondering if you knew anything about preventing hair loss. My mom has thinning hair and my dad and older brother are both bald (both by their mid 20s). I am 24 right now and have no noticeable hair loss. Everyone but me in my family is overweight/obese so I suspect a generally inflammatory diet could precipitate hair loss. Is hair loss inevitable, or can diet help prevent it? Thank you!


  25. Thanks for all the wonderful info in the book, on the website, and here in the Q & A.

    I’ve been eating close to PHD for the last three years. I’ve had chronic fatigue syndrome for many years, which has improved a lot when I cleaned up my diet.

    I’ve been on gaps for a couple week for further healing, but some things are worrying me. I have
    – muscle loss
    – lost 2-3 pounds – any more and I’ll be seriously underweight.
    – I seem to be having some eye issues
    – dry mouth
    – dry eyes

    I can’t afford to lose muscle mass. It’s not like I can go into a gym and build it back up.

    Because of the symptoms, I’ve started to eat tons of cooked vegetables, vegetable juices, added acorn squash, added fruit during the last two days – all of which are allowed on gaps- but the symptoms persist.

    Gaps excludes disaccharides. If I eat some rice or potato, am I basically negating the premise of gaps? Can you explain the difference between getting carbs from gaps-legal sources versus from starches, both from the fuel point of view and also from the point of view of starving the beasties.
    One last thing, in response to Lena you spoke about infections in or around the eyes. My eyelids, especially my right eyelid has been itchy for the last couple months (since before gaps). Could this be a sign of something?

  26. One more thing. I just weighed myself, and though I’ve been trying to eat a lot, I lost more weight. But more alarmingly, I could barely read the scale. My eyesight is definitely worse.

  27. Hi Andrea, I too have been working with both PHD and GAPS. The underlying philosophies differ somewhat and I have found both approaches helpful. But, it sounds to me like you are trying to follow GAPS religiously despite the signs that you aren’t doing so well (I also had worse eyesight!). Perhaps you could consider having the safe starches again and see if this helps? That or try having (lots of) rice syrup (also ok with gaps because its monosaccharides) or lower fructose honey (darker color I’ve heard is lower in fructose). This keeps my weight up. Best of luck! Claire

  28. Hi Paul-I’m a 67 yr. old male in good health,could stand to lose some body fat,and have been lifting heavy weights most of my adult life.I have started donating blood,I like the idea of helping out.Are there any health benefits to this and is there any negatives involved?My blood iron is consistently in the higher normal range…Thank you for this Q&A forum.

  29. Hi Paul,
    I’m almost finished with your book and can’t thank you enough for this valuable information.

    I am a 58 year old female and have no weight issues. I do have a terrible problem with getting up several times at night to go to the bathroom. I’ve had this problem off and on for years, but noticed that it has been better and worst at different times in my life but can’t pin point why. I just have a feeling it’s diet related. I’ve tried Doctors and it’s all a guessing game with them also. I recently started taking Melatonin, 5-HTP and L-Theanine for sleep. I’m wondering if these supplements have anything to do with it. I take them right before I go to bed. The supplements have improved my sleep but very interrupted sleep with all the trips to the bathroom. Could increasing my animal protein intake have anything to do with it??

    Any help you can offer would be so much appreciated.


  30. Paul,

    I emailed you right before you put up this q&a, don’t know if you remember. I have the histamine problem, or something. I am really glad you have this q&a, + the blog, and I am getting the book with my next Amazon purchase. Thanks so much. Also, all of the people posting are so incredibly kind and helpful. This is a really great community and I hope I can also contribute.

    I am not sure my underlying problems, but I am SUPER sensitive to many foods. I got sick about 3 and half years ago, although I had symptoms prior to getting sick. When sick, I mean that I had a virus of some sort, then afterwards gained a lot of weight, was sick all the time, brain fog, fatigue, then developed or discovered numerous food sensitivities. I tried SCD back then, but had horrible cravings, then thought maybe my problem was fructose malabsorption (apples + honey make me feel hungover the next day still), then thought corn allergy (absolutely cannot tolerate refined corn), and now my problem seems to be histamine intolerance (yes, I read ThatPaloGuy/Jaimie’s post about it and the paper he referenced). Maybe its all of the above – but maybe these are all symptoms. I tried GAPS + buckwheat starting last February, and realized I could not tolerate ferments on top of everything else (I do have problems with all of the high histamine foods). I have had a variety of reactions, including headaches/migraines, GI, sleepiness (I pass out if I eat cornstarch), mood problems (depression), nasal congestion/sore throat, acne. Most of this is gone now, but not all.

    Last summer I started taking acetyl glutathione and getting IV glutathione and it helped tremendously. Many of the histamine reactions were subdued, although they still continued. I was able to tolerate pasteurized but not raw milk. That was huge at the time. About a month ago, after reading your blog more carefully, I decided to try white rice. Well, that helped tremendously! I lost a few pounds and am not hungry all the time. Also, all cravings and temptations gone.

    Here’s the question- its about supplements and direction. I do not really like taking supplements because I spend a bunch of money and always have reactions. My doctor (Dr. Cowan of GAPS fame) suggested more supplements for my liver: milk thistle and r-ala. I tried both and had bad histamine episodes (headaches, sick, no energy). I do take probiotics and the acetyl glutathione.

    Last weekend I decided to try the Vitamin C flush and figure out my bowel tolerance for Vitamin C. I ended up tolerating 43.5 grams, and have been taking about 30 grams a day since. I feel so much better!! No headaches from the asparagus or potatoes, more energy, etc. I almost feel normal. Last night I started getting a slight cold. I haven’t been sick with colds/viruses in many years. I think this is a good sign. What do you think?

    Diet-wise, I have been doing whole foods, no wheat, no seed oils, no nuts/legumes (but very limited – beef, chicken, and some veggies) with bone broths. I can follow most of your recommendations (not fish, and I am not sure about coconut oil). I do have milk (but hot) every day. I also do not think I am strong enough to do any intermittent fasting. I need to eat pretty consistently.

    What direction would you point me towards? I know you recommend a lot of supplements, and for me I need to do one at a time, slowly. Would you make any suggestions in terms of supplements or diet?

    Thanks again, and I hope I can share some of my experiences and help others.

  31. For Naomi,
    Have you been evaluated for systemic mastocytosis or intermittent mast cell activation? Symptoms can include flushing, palpitations, nausea, headache, syncope (fainting), rhinorrhea, gastrointestinal disturbances and abdominal pain. Intermittent mast cell activation can be very difficult to diagnose. Mast cell problems can be misdiagnosed as histamine sensitivity.

    Have you had a serum Tryptase test? “Passing out” after eating cornstarch is particularly worrisome. Do you have an epi-pen? Those with mast cell problems can be “shockers” or “leakers” and a failure to get diagnosed can be deadly.

    The Mastocytosis For A Cure (www.tmsforac.org) is launching a new site soon.

    Few doctors know about mast cell problems including allergists so educate yourself and insist on getting a baseline serum Tryptase if these symptoms seem to fit your case. Best of luck to you.

  32. I have already posted this question elsewhere on the blog (wrong place, my mistake):
    I would like to inquire about tapioca starch/pearls and progesterone (or possibly phytoestrogen). I have found several articles about how yams/cassava contains natural progesterone. Actually, some African tribes seem to have extraordinarily high twinning rates because of eating cassava/taro as a staple. On some websites, tapioca pudding is even recommended as a method to increase the likelihood for a twin pregnancy! For me, it is absolutely important not to eat food that might influence my hormonal situation at the moment as I wish to become pregnant but do not want to increase my risk for multiples or mess my hormones in general. On the other hand I like to make deserts with tapioca. Do you know about the amount of progesterone that is contained in the pure starch? Is it relevant in moderate amounts?
    I thank you veray, very much!

  33. Sweet Feather – no I have not been evaluated for mastocytosis, but have read about it. The “passing out” is more like falling asleep, not fainting. I forgot to mention I do have hot flashes, which are definitely a food reaction. No, I do not have an epi-pen, I’ve never felt the need for that (plus I’d probably react to it anyway). I’ll look into your suggestions. However, I think I read about it awhile ago, and for some reason it didn’t stick. But I will re-evaluate and ask my doctor if it fits at all. Thanks.

  34. Naomi, does your face turn red and sweat during the “hot flashes” or are you pale with cold extremities with a feeling of a hot wave cresting over and over you?

    My doctor had me do an H1/H2 (zyrtec/zantac)blocker trial. (a week on them, a week off and repeated again) I feel 200 percent better when I take a zyrtec and/or claritin and a zantac every morning. I have an order for a serum tryptase and methylhistamine test if I have a bad histamine/mast cell??? reaction “episode” but they’ve stopped since I started the blockers. A trial like this is a relatively inexpensive and safe (OTC and non-invasive) way to confirm a histamine problem although it won’t give you a definitive diagnosis of what is causing it. I don’t know if H1 and H2 blockers would help in your situation but you could ask your doctor about it.

    I feel so much better moving to the PHD from GAPS. I’ve found potatoes make me carbcrazy so I rarely eat them. My eyes aren’t as dry and my appetite remains normal when I eat rice although I don’t eat it every day. (Thanks, Paul!)

    Paul, do you have any special recommendations for people on the PHD, like me who are on H1 and H2 blockers on a regular basis? I know I need to try to eat low histamine but does anything else come to mind?

    Good luck , Naomi. Thank you, Paul.
    My best, SweetFeather

  35. Hi Paul, i thought some of your readers might be helped by my story.

    To keep it short ive had 2 bouts of long lasting
    chronic hives and angioedema. (Along with IBS, the first time was stomach cramps, the second time was persistent diarrhea).

    After spending a lot of money (herbs, diets, tests, allergists etc) I found a few things that truly helped.

    Firstly, Grapefruit Seed Extract (GSE). After trying this my symptoms halved in 24 hours and were gone in a week.
    Over the years since then, several small flare ups have responded immediately to GSE.

    A happy ending, till about a year ago when I developed the same problems but GSE wasn’t helping much.

    This time I added Colostrum powder, the hives/angioedema responded immediately but the diarrhea remained.
    After adding lactobacillus plantarum 299v my diarrhea was/is 95% better.

    Perhaps it’s all placebo or coincidence (as my local doctor sternly informed me) but the cost is small and I would advise anyone with similar symptoms to give these items a try.

    On a side note ive noticed the old jazz/RnB clips you occasionally post. Hope you like this one… (wait for about the 2 minute mark!)


  36. Hi Paul,

    I take all your standard supplements plus probiotics. How am I best to divide them up during the day?

    I take the probiotics first thing in the morning and all the other supplements with my middle of the day meal.

    I know the Vit D should stay in the middle of the day, but should I split the others up to help with absorption?

    I do currently eat three meals per day so how should I split up the Multi, K2, Mag, Copper, Chromium, Iodine, Selenium and Vit C.

    Thanks so much.

  37. Hi, I’ve got an annoying itch on the anus and the scrotum. Perfect Health Diet does not eliminate it. When I don’t eat carbs the itching is more severe. Potatoes seem to soothe the itch. My doctor says I have stress. I don’t believe it. When I eat carbs for dinner (mainly rice) I wake up next morning with a white slimy film in my mouth. It’s pretty gross. I can run my finger along the bottom row of my teeth and gums and pull out a lot of it. Do you think I have candida? Thanks.

  38. HI Paul,

    I have a question in regards to cigarettes. Whenever I am smoking, I am able to eat the correct foods (almost 100% PHD with ease) and always have energy,etc. When i’m not smoking, and before I started smoking, I was always fatigued, always overate to compensate,etc. I know for a fact that my symptoms have nothing to do with cigarette addiction, only because i just started as i could not stick to healthful eating without unrelenting force of will(which ended up stressing me out even more). I know everyone says they’re bad but is there a possible give and take? if nutrition really does have such an impact, maybe the benefits of being able to stick to a good diet outweigh the cons of smoking? ANy advice or input would be most appreciated. Thank you very much for any time or consideration.

  39. HI Paul,

    I have a question in regards to cigarettes. Whenever I am smoking, I am able to eat the correct foods (almost 100% PHD with ease) and always have energy,etc. When i’m not smoking, and before I started smoking, I was always fatigued, always overate to compensate,etc. I know for a fact that my symptoms have nothing to do with cigarette addiction, only because i just started as i could not stick to healthful eating without unrelenting force of will(which ended up stressing me out even more). I know everyone says they’re bad but is there a possible give and take? if nutrition really does have such an impact, maybe the benefits of being able to stick to a good diet outweigh the cons of smoking? ANy advice or input would be most appreciated. Thank you very much for any time or consideration.Comment

  40. Paul, about a week ago, I noticed a white patch under each eye and now it seems to have spread down on my cheeks and across the bridge of my nose. I checked the malar rash of lupus and it’s nothing like that. It looks like someone who may have been out in the sun with goggles on.

    My diet hasn’t changed.

    For breakfast: Half cup of coffee, Shake w/ 1/2 C. berries/ T. whole milk yogurt/half banana/T. MCT/half packet gelatin/very small bowl of Rice Chex.

    One meal about 3 PM of meat, fish or eggs, safe starch, assorted veggies & one square 90% chocolate.

    I use mostly butter for cooking only occasionally olive oil. I rarely eat uncooked vegetables and wilt the salad for myself when I make one for my husband.

    In the evening, an occasional a piece of fruit, a couple of Quaker lightly salted rice cakes with cheese or a no-sugar small fudgicle.

    Beverages only filtered water and coffee with a rare small can of ginger ale if my stomach feels queasy.

    I take all your suggested supplements including Choline, Primal Defense Probiotics & Raw Enzymes.

    Anything come to mind?

  41. Hi Paul et al,

    My 17 year old son suffers from severe chronic allergies starting around the age of 2 yrs old. We went to an allergist and found out he is allergic to dust mites, grass, oak, and dogs( scratch test). He is currently taking Zyrtec during the day and at night Benadryl with little relief. He suffers from intense itching, welts, hives, eczema, redness and swelling around his eyes, mainly on his face, neck, and arms. His symptoms mainly the hives and itching get worse at night and tends to get a little better during the day. We are at a loss. We have tried everything the allergist recommended and nothing seems to help. We’ve also removed gluten from his diet. What do you recommend for dietary changes? He looks and feels terrible. Any help would be greatly appreciated.



  42. Hi Paul et al,

    I feel a little bit confused with the connection between very low carb and fungus. Confusion started after reading your data about the relation of fungus and very low carb and compared them with the information provided in the book The Fungus Link Vol 1 of Doug A. Kaufmann. In this book Mr. Kaufmann at first showing clues about the possible link between fungus and many health problems like allergies, arthritis, digestion mental health etc. At the end suggests a very low carb diet to starve the fungus. The imunne system needs a specific amount of carbohydrates for controlling fungus and in the same time fungus getting stronger because provided with food?

    Thank you in advance.


    George Georgas from Greece.

  43. Hello, all:

    I am a chronic migraneur and my headaches are getting worse. I eat a basic paleo diet, but do not weigh my food or count grams of food. I am not overweight.

    I would like to try a ketogenic diet, but am confused about what exactly I can and can’t eat. I also am not clear about the protocol to follow.

    What is a good and detailed resource I could follow?

    Many thanks.


  44. Deb, did you read the book or the information about the basic PHD diet? Start with the basic PHD diet….at the top of the page…. where it says THE DIET.


  45. Honeybee,

    Have you read all the information on the posts in the category labeled MIGRAINE? (on the right had side of the page)


    and all the comments too

  46. George,

    Obviously Paul disagrees with Doug Kaufman.

    All I ever heard about the optimal diet for fungus is to not eat any carbs and starve the fungus. This blog was the first time I heard about needing SOME carbs to fight fungus or about how very low carb and ketosis actually feed fungus. And at first it was a big shock and confusing to me too because it was so contrary to what “everybody knows is true”.

    But so far my experiments along the lines that Paul suggests have made great inroads on clearing up my fungal issues.

    While years of eating very low carb and going into ketosis only made things MUCH worse.

    Self experimentation may be all the proof you need.

    Here is more detail about my experience


    it is in the comments around May 11

    Read the results page for more information/

    Paul promises us that he will be doing a complete fungal post sometime, but meanwhile there is a lots of information explaining his thoughts and reasoning on fungus that you can find by reading the archives.

  47. Thanks Ellen for your respond.

  48. Does anyone know if there has been information regarding Arthritis on this site— Rheumatoid arthritis Arthritis. My husband suffers from chronic arthritis. He is in pain all the time, medications don’t help. He has a family history of this disease. I looked through the site but didn’t find anything.
    Thanks so much

  49. @Ellen – Thanks for your reply.

    Yes, I have read them all, but I am ashamed to confess that I am still not clear on how to start and proceed.

    I’m the sort of person who needs a detailed explanation, and that’s why I am looking for a good book that breaks down how to do the diet very specifically.

    I’ve googled the diet and have come up with a lot of information, but it’s a bit overwhelming.

    If you know of a specific recommendation for a ketogenic-diet-for-dummies type of resource, I’d be grateful.

  50. @Ellen: I forgot to add that I’ve never counted calories or grams of anything in my life, so I was wondering if the most straightforward thing would be to read the Atkins book to get me started.

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