Q & A

Q & A

This page as an open thread for reader questions, especially questions about personal health concerns.

I am putting this page up as a way to share knowledge — my knowledge with questioners, but also so that others with similar concerns can read the conversation, and readers with relevant knowledge can chip in with their own thoughts.

Please keep in mind that I can’t research questions in any depth, so my answers should be considered tentative, incomplete, and subject to later correction. Also, I am not a doctor, and nothing I say should be construed as a substitute for medical diagnosis and treatment. I am only sharing opinions about disease origins and general therapeutic strategies which may or may not be applicable in any given case.

To get the page started, I’ll put up a few questions from recent emails. Here is an index by disease, with clickable links:

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


Been following your work on the PHD before the publication of the book and commented on my CLL and the usefulness of Vitamin D once on your blog and you responded to keep an eye on my Vitamin K intake, which I do now.. Am fortunate in a way to have my form of CLL as it indolent which gives me the opportunity to experiment without the pressure of undergoing conventional treatment. The PHD, I think, is helpful in this regard.

Wonder if you could point anything out to me that may be useful. Anything at all. And I will be happy to share with you my results.

Surely you know of the helpfulness of green tea with CLL. You may not be familiar with research that points out that those with low levels of Vitamin D need treatment for CLL far sooner than those with elevated levels.

Feel strongly that your version of a ketogenic diet would be helpful but also feel I need some direction in this area. Do you have any suggestions?

Warmest Regards,


Hi A,

I remember your comment, thanks for writing back. I’m glad you’re enjoying our diet and wish you the best.

Thanks for the tips about green tea and vitamin D. Neither one surprises me.

Most likely CLL is caused by a viral infection. So enhancing viral immunity is probably a good idea. Good strategies may include: (1) low-protein dieting, which inhibits viral reproduction and can promote autophagy; (2) maintaining high vitamin D levels; and (3) intermittent fasting, which promotes autophagy.

Some food compounds have been reported to have antiviral effects. An example is green tea catechins, eg http://pmid.us/16137775, http://pmid.us/18313149, and http://pmid.us/18363746, and this could be why green tea is helpful against cancers, http://pmid.us/21595018, which are usually viral in origin.

I might search Pubmed for herbs and spices with antiviral effects, and use them abundantly in cooking, along with antiviral foods. Turmeric / curcumin is a good choice, this needs to be taken with black pepper to enter the body. See http://pmid.us/21299124, http://pmid.us/20434445, http://pmid.us/20026048.

Coconut oil / lauric acid also has some antiviral properties, so inducing ketosis with coconut oil could benefit you even aside from the ketosis. You could also try monolaurin supplements which may enter the body better and which some people have reported to help viral infections.

You might also try HDL-raising tactics as discussed in this series: HDL and Immunity, April 12; HDL: Higher is Good, But is Highest Best?, April 14; How to Raise HDL, April 20.

Another possible tactic is high-dose riboflavin with UV exposure on the eyes. This requires going outdoors at midday and not wearing glasses or contact lenses. Riboflavin+UV is toxic to blood-borne viruses, and the retina is a location where UV can reach circulating blood cells. Sun exposure will also help you optimize vitamin D.

That’s a few ideas, at some point I’ll do some research to come up with more and do a blog post. Do keep me posted on your results!

Best, Paul

Bloating, acid reflux, anxiety, depression, hypoglycemia, hypothyroidism, fatigue

Just came upon your website and had a question for you. I have had some health concerns for the last four years, bloating, acid reflux, anxiety, depression, hypoglycemia symptoms, female complaints (I am in my forties), thyroid antibodies at 333, weight gain around my middle and too tired to work out like I once did. I used to be fikiiled with energy and great health no depression or anxiety. My doctor thinks these symtoms are all from peri-menopause and wants to treat me with Zoloft.

Needless to say I have tried to avoid the Zoloft. I have tired every avenue out there to cure myself. Most recently the Primal type diet. When I eat no grains or dairy I get horrible hypoglycemia symptoms and don’t feel great like everyone else on a low carb diet. I feel weak and more anxious. Do you think your diet would be easier for me with the addition of rice and potatoes?


Hi G,

Yes, I do think our diet will be better for you. You should eat enough starches to avoid hypoglycemia.

The key thing for you is treating the infections which are consuming so much glucose and making you glucose-deficient if you don’t eat enough carbs. Whatever pathogen(s) this is, it seems to have infected your gut and caused the various gut problems; circulating pathogen-derived toxins and immune cytokines are probably responsible for the anxiety and depression. Hashimoto’s hypothyroidism may be either due to circulating toxins or a thyroid infection.

I would suspect some kind of protozoal or parasitic infection due to the hypoglycemia, but what I really recommend is getting your doctor to have a stool sample analyzed for pathogens. Metametrix has a good test. Once you know what pathogen to treat, and get on a better diet like ours, you should improve quickly.


I am writing on behalf of my mother … We live in Dhaka Bangladesh …

Before her illness, my mom was 105 lbs, 5 feet tall and always 10ft tall in spirit…. When she was diagnosed with Lupus at the age of 30, we were all overwhelmed and out of our depths. My beautiful, athletic mother was in a wheelchair and given 6 months to live….

The doctors has advised her to eat literally nothing, minimum protein (1 small piece of chicken/fish, limited to 20g protein per day), only 2-3 types of vegetable and 2-3 fruits and of course lots of carbs to apparently compensate for her failing KIDNEY and LUPUS. She is on tons of medication, no food except the wrong foods (carbs) and in chronic pain. She currently weighs 139 lbs.

Please advise. — S

Hi S,

I believe lupus is a catch-all diagnosis for a variety of conditions which are probably caused by undiagnosed infections. In the US the infections are usually bacterial. I’ve known several people with diagnosed lupus who were cured by antibiotic treatments – in one case the problem was Lyme disease (Borrelia). I have no idea what the likely pathogens would be in Bangladesh. If she does better on low carb and coconut oil, that indicates bacteria; if she does better on high-carb, that indicates protozoa.

A healthy diet is very important. It is very bad advice to “eat literally nothing,” it is essential to be well nourished. Protein is necessary for healing and immune function, and 20 g/day is too little. Fasting is good, but it should be intermittent – not starvation! She needs healthy fats, more protein, and lots of micronutrients. Eggs, shellfish, seafood, bone broth soups, vegetable soups, and fermented vegetables may all be helpful. Coconut milk is probably good for her. You should basically follow the program in our book.

I would try to put her on a good diet, give her a little time for kidneys and other tissues to heal, and then try antimicrobial medicines. Usually, if they’re not working, then you don’t notice an effect. Any strong effect, good or bad, means they are working. Bad effects mean that pathogens are dying and releasing a lot of toxins as they disintegrate. If this occurs, detox aids (salt, water, and one of cholestyramine/charcoal/bentonite clay; also glutathione supports and vitamin C) will help.

Please stay in touch and let me know how things go.

Best, Paul


Jersie wrote:

I’ve suffered from depression for decades. A few months ago, I decided to try the Dr. Kruse protocol for jumpstarting leptin sensitivity and 2 interesting things happened.

When I went very low carb – below 50 gm -. I had half-day periods where the depression suddenly lifted (something that has rarely happened otherwise). However, I also suffered from darker than normal periods.

I stopped the Dr. Kruse protocol after 6 weeks, and went back to regular paleo (approx. 200 – 300 gm. Carb/day). I’m now generally more depressed than usual, without the good periods.

These changes seem to indicate that I can have an influence on my depression with diet, but not sure what diet to try. Thoughts?

Hi Jersie,

I think your experience on very low carb is diagnostically telling.

I would interpret it this way:

  1. Your depression is caused by an interferon-gamma mediated immune response in the brain, probably caused by a viral or bacterial infection. This leads to tryptophan being directed away from serotonin and toward the kynurenine pathway. So you have a serotonin deficiency and kynurenine excess.
  2. A ketogenic diet is both therapeutic (promotes immunity against bacterial and viral infections) and mood-improving (clears kynurenine).
  3. However, you are at risk for hypoglycemia in the brain (especially if the infection is bacterial) and hypoglycemia causes irritability/anxiety and can aggravate depression.

So the very low-carb diet had mixed effects (ketosis, hypoglycemia).

What I would do is follow our ketogenic diet advice. Eat at least 50 g/day carbs from starches to get sufficient glucose, plus sufficient protein to reach 600 calories/day protein+carb, but add in large amounts of MCT oil or coconut oil. Also, do intermittent fasting – eat all the carbs within an 8-hour window; eat at least half the MCT oil in the 16-hour fasting window.

Once on a good diet, I might experiment with antibiotics to see if they relieve symptoms.

Please let me know how things go.

Leave a comment ?


  1. Paul,

    Thank you for getting back to me so quickly. An internal fungus would perhaps explain why the only thing I cannot figure out in my metametrix test is unknown parasite (tested twice in a row) and the fact that I have antibodies not just against the thyroid but for instance phosphatidic acid, implicated in miscarriage, and that this skin rash may well be something similar to lupus. Every time I test fot some antibodies, they are there! The diet has helped me a lot but I still have too much inflammation due to infections. I wish there were more doctors willing to try things.

    Thanks Paul, you are such a wonderful (and kind) source of information in my quest for health.


  2. Hello Paul,

    I am currently in China. Would you recommend eating organ meat from local markets in a major city in China?

    This question may not be in your scope but seeing as you have a personal connection with Asia through Shou-Ching I thought it couldn’t hurt to see if you have an opinion.

    • Hi Cameron,

      Well, we don’t know the answer. Presumably some are safe and some aren’t.

      You may recall at the recent Olympics the Chinese athletes may have suffered due to a prohibition of eating Chinese meat due to its widespread adulteration (http://www.reuters.com/london-olympics-2012/articles/volleyball/2012/07/03/china-panics-over-meat-free-diet-athletes).

      Also, a large fraction of the world’s new infections originate in southeast China due to mixing of animals and people in close quarters. In general meat should be thoroughly cooked (by a gentle method such as boiling, ie in a stew) to kill pathogens.

      It is a judgment call and really depends on the local conditions.

      • Ok interesting. I’m trying to source organic meat from a shop over in Hong Kong which will be good. But they don’t sell organic organ meat. Damn!

        Thanks for the slow-cooking recommendation.

        I can’t believe parts of the world like this hardly give a damn for ensuring food they put into their own bodies is clean. It is a symptom of a larger problem unfortunately

  3. Probably pork organs would be the first to avoid, because of Hepatitis E risk, ruminant organs should be safer if well cooked. Pork is a better conduit for new diseases, being closest to human.
    Insects should be the safest source of protein if in doubt…

    • Thanks for the reply George.

      Is fat, specifically pork fat, a place where pathogens/parasites/and other baddies like to call home?

      I cook a lot with lard. Maybe this is not such a great idea here in China?

  4. Lard would be OK – it is places where blood and nerves are found that are virus reservoirs. Liver, brains, not muscle or fat. Preserving and cooking kills anything. The heat of cooking with fat would purify it in any case. I would just watch for raw or undercooked food or raw food that’s been in contact with such, or washed with dirty water.
    If in doubt, eat fruit or veges you can peel, or food that’s been cooked.
    My friend is an immunologist, he went to China and said he was struck by how healthy people there looked next to New Zealanders.

  5. George,

    Sounds like NZ is just as bad as Oz (where I’m from).

    You rarely see any Chinese overweight here, especially women. But I think that the level of health here is changing.

    You do see a lot of acne, the same as you would see in the Western world. Processed food is rampant, baby formula’s are everywhere, vegetable oils are used, rotting teeth, etc.

    I would like to get over to NZ one day George. At least you guys have got a raw milk self service vending machine. =)

  6. Hi Paul,

    I always mean to ask you this and then somehow forget. What do you think of the Roddy/Peat/Stone view of sugar being extremely helpful for stress relief? I know that sugar is maligned on the PHD, but there seem to be many anecdotal accounts of sugar being therapeutic in times of stress.



    • Hi Lindsay,

      I can believe the anecdotes, it’s not by accident that people reach for sweets under stress. But as a routine part of the diet, it’s harmful. It moves the gut flora in a bad direction, creating inflammation. It has other harmful effects.

      Also, just eating in general helps relieve stress — it doesn’t have to be sugar, although that may have the quickest effect. A healthy tasty meal might be a healthier way to relieve stress.

  7. Paul,

    What were the results of your CBC/FBC like when you suspected CAP?

  8. Speaking of blood tests, Paul, do you consider the hs-CRP test a good marker for measuring inflammation? Mine shows no inflammation by the lab standards @ 0.33. I am hoping I can eat nightshades like tomatoes, eggplants and peppers again. I am eating potatoes again at your suggestion (and loving it)! What is your opinion on this? Thank you!

    • Hi Dede,

      CRP shows you have inflammation when it is high but low doesn’t necessarily mean everything is perfect. I don’t know if CRP tells you anything about whether you are nightshade sensitive or not.

      I would just give the nightshade vegetables a careful test and see how you respond to them. The Weston A Price foundation has an article on doing a nightshade “party day” to test for sensitivity.

  9. Well I could certainly have a party with the nightshade family considering I LOVE tomatoes, eggplants, peppers, etc.! Thank you as always for shedding light on things I don’t understand! You, your site and your diet are a gift to us!

  10. Hi Paul, 2 Questions
    1.What coconut oil do you recommend, and what is the difference between organic unrefined COLD-PRESSED extra-virgin coconut oil and EXPELLER-PRESSED unrefined WHOLE KERNEL virgin coconut oil?

    2.If I am taking copper supplements is it ok to also eat liver once per week or is it possible to overdose on copper?

    Thanks, Syl

    • Hi Syl,

      Any coconut oil whose taste you like is good.

      Yes, you can overdose on copper. Limit yourself to 1/3 lb beef or lamb liver per week, or 2 mg/day supplements, but not both.

  11. Dear Paul,

    First of all, I’d like to thank you for what you do. To me, you are a super hero.
    Also, I’m already looking forward to reading your new book! 🙂

    I am currently on PHD + all the supplements in order to recover from eczema, chronic fatigue and some other minor issues and I have a few questions regarding that.

    1) I am too lazy to make bone broth. I know that a lot of folks that are used to making it think it’s easy; however, I’ve tried it several times and it’s just not my thing. And amongst other problems, it takes up too much space in the fridge 😐 . However, I do eat the skin on my chicken wings, the skin on my wild caught whole fish and mix some store-bought gelatin into my spaghetti bolognese sauce. Will that have similar gut-healing properties?

    2) You warn against fungal probiotics for patients with gut disease. I skipped the kefir and went for fermented mixed vegetables for that reason. Now, I recently found an almost PHD-approved bread-baking-mix (it contains some quinoa but not much). However, the recipe calls for yeast. If you heat probiotics (e.g. during pasteurization), the bacteria will die. So will the yeast also die during the baking process? Or will they colonize my gut and cause harm?

    3) I recently came across a butryc acid-supplement on the internet. Do you think it’s effective for healing the gut?

    4) I recently found out that I have subclinical hypothyroidism and suspect that’s the main reason why my gut is still leaky altough I’m on paleo since almost two years (not all of that was phd, obviously). I started supplementig with 400 mcg iodine two weeks ago and plan to slowly double the dose every month. Since I’m off gluten for so long, is there still the possibility that I have auto-antibodies against the thyroid? I am going to see my doctor next week because I want to do the test; however, I’m a bit worried that my doctor doesn’t know about the test or that It’s just not available. What would you recommend me to do in that case? Obviously I’m already taking vit D, selenium, magnesium and all the other thyroid co-factors. Do you think it would be safe for me to increase the iodine in that case although I’m a gut disease-patient?

    I wish you all the best,


    P.S.: Sorry for any grammatical mistakes. I come from Austria 😉

    • Hi Luke,

      You can get collagen from some of those food sources, though you can get more by including joint material in soups or stews; you should also tend to calcium by eating green leafy vegetables, dairy, and possibly supplementing calcium once in a while.

      I think it’s OK to use yeast in baking. They will die in cooking. It is live fungi that are more of a concern.

      Yes, I think butyric acid is helpful. I’m told it tastes awful however.

      Yes, you could have autoantibodies against the thyroid. This can happen due to infections as well as due to wheat consumption. Iodine supplements often lead to reduced levels of autoantibodies. … Safety of iodine is a complex topic, you might check old posts in the hypothyroidism category for more extensive treatments.

      Best, Paul

  12. Hi Paul,

    It’s hard to believe this is my first comment here, seeing as I’ve followed your blog, passed out copies of your book, and basically been a believer (and fan) for quite some time now. Your hard work and balanced perspective is much appreciated, and I am looking forward to the new edition! That said (and long overdue), I would love your thoughts on a recent cholesterol panel that has me concerned. Brief background: I “went paleo/primal/ancestral” in January of this year, quickly shed 20+ stubborn pounds which was significant on my 5’3″ frame, and started feeling healthier pretty much across the board. I rarely miss the grains, sugar, etc., and in general have found the positive results more than enough incentive to stay with the program, as success is the great motivator. However, prior to paleo, on a considerably lower-fat diet, my total cholesterol was around 175, LDL 89, HDL 65, and Triglycerides 48, while a very recent panel returned lab values of TC 264, LDL 182, HDL 74, and TG 39. I’m in my mid-fifties, slender, BP is good (112/72), and the only change has been in my diet. While I realize that the ratios are fairly good, I was stunned to see LDL and TG skyrocket to this extent.

    I supplement with vitamin D, vitamin C, K2, Potassium, Krill Oil (it has greatly helped stiffness in joints, although I know you don’t tend to recommend it), Curcumin, and a probiotic. I eat eggs, meats (grassfed when possible), coconut oil, and fresh fruits and vegetables. I’m probably overdoing the almond butter, and under-doing the vegetables. I also need to up the exercise, which is an ongoing struggle with my 70-hr. work week. Nevertheless, I am quite concerned with these numbers, and of course my internist is not pleased. So what do you think, should I be worried? Any thoughts or suggestions would be welcomed.

  13. Hi Paul,

    I’ve written several times about a health mystery that has baffled me for years: my total cholesterol is always less than 150 and LDL hovers around 80. Regardless of diet, dietary cholesterol intake, etc.

    I’ve exhausted all the avenues I can think of for understanding and solving this problem. So at this point I’m just wondering how harmful it will be to leave the damn thing alone.

    I know that your answer to this question will be purely speculative, but I’d like to hear your opinion nonetheless: how harmful do you think it would be to live the rest of my life with a TC of 140-160 and an LDL of 80?

    I cannot find any but the most cursory information on causes of low cholesterol, and doctors dismiss me when I tell them that I think low cholesterol is a problem.

    It seems that the cause is either genetic or infectious: if genetic, the only solution would to obtain quantities of dietary cholesterol too massive to be practical or even achievable without tremendous effort and inconvenience; and if infectious, then I don’t even know where to begin, what infections to look for, or how to treat them safely. Doctors dismiss me when I try to talk to them about a connection between low TC and infections. So this problem appears pretty much insoluble.

    So how bad do you think it would be to just leave it alone?

    • Hi Brendan,

      I still think a protozoal or parasitic infection would be the most likely possibility. Having tested and treated for parasites, a protozoa like Toxoplasma or Plasmodium or Trypanosomes might be more likely. Here is a summary of what is known: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1142336/

      Most people who have these infections live with them without treatment.

      If it’s not impacting your health in any obvious way, that’s good. I would still try to diagnose it if possible.

      • Thanks, Paul.

        I’m not sure whether it affects my health significantly, but I do have a number of lingering symptoms that haven’t really been resolved, despite having gained a pretty advanced understanding of nutrition and biology.

        An interesting note: one of the drugs I took to treat the intestinal parasites was Alinia (nitazoxanide). As far as I know, nitazoxanide is absorbed into systemic circulation and would thus be expected to impact systemic pathogens as well. I vaguely recall feeling better during the time that I was taking it, but memory is always foggy and if there was a difference it was a subtle one.

        I probably didn’t take it long enough to have any lasting effect, though–only 3 days.

        I’ll continue the search, and if I find an answer I will report back.

  14. A couple of interesting points to add:

    1. I did test positive for intestinal whipworm and entamoeba on a stool test–I think I mentioned that in a comment that you featured in Around the Web a while back–but then I treated both and tested negative for both on a follow-up test, and my cholesterol has remained low. So if there’s a pathogen that is consuming cholesterol, then it must be a systemic pathogen.

    2. My girlfriend has been developing symptoms similar to mine. She was recently tested for TC and LDL and her numbers are virtually identical to mine. Is it possible that I have transmitted an infection to her, and it’s had the same effect on her blood lipids? Or might we just both have the same genetic defect in cholesterol synthesis?

    Thanks for your thoughts.

  15. there are hereditary variations in cholesterol; 150 is average in some parts of the world. If you don’t eat much, it may just reflect that.
    An infectious agent that will lower LDL and TG – and maybe elevate HDL – is hepatitis C (HCV).

  16. individual genetic variants in APOE, APOB, LDLR, and PCSK9 (were) associated with stepwise increases/decreases in LDL-C of up to +59% compared with non-carriers (p <0.001)


  17. Thanks, George.

    Regarding hepatitis C, I tested negative for all hepatitis-related antibodies about a year ago, and my low cholesterol preceded that test by at least 3 years.

    Are the antibody tests reliable?

  18. Hello Paul,

    I believe I implemented all of your ideas to my life as I can, and my question is am I missing anything?

    I am a 27 year old alcoholic who drinks 2-3 bottles of red wine a night. That probably won’t change but I want to design the healthiest diet around an unhealthy condition.

    After reading your book I implemented a couple of things. I now separate pufas consumption with alcohol by keeping 8 hours between any meal and alcohol consumption. I switched from beer to wine to reduce grains. Currently I eat one large meal at noon full of vegetables and beef or salmon and leave 7 hours between the meal and alcohol. I take the vitamin C and N acetyl cysteine with lunch along with the other recommended list of supplements.

    Any further thoughts for harm reduction?

  19. Hi Paul,

    I have purchased 5mg Lithium, but it is in capsule so I can not split it. Can I take it every other day?
    Also what do you think of Nattokinase for general health?

    Just an FYI, “In one study, researchers explored the amyloid-degrading ability of nattokinase.13 Results demonstrated nattokinase was effective in hydrolyzing amyloid fibrils. In fact, it was effective in hydrolyzing three different amyloid fibrils. These included A?40 fibrils (found in Alzheimer’s disease), insulin fibrils (caused by repeated insulin injection of diabetes patients) and prion peptide fibrils. The researchers concluded, “the amyloid-degrading ability of nattokinase suggests that it may be useful in the treatment of amyloid-related diseases.”

    • Hi Steven,

      Well, give it a try, but I find 5 mg is too much for me and 2.5 mg is even too much for Shou-Ching.

      You might be able to open the capsule and split the powder into portions.

      • Paul,

        I do not feel anything specific when I take it, is there something I am supposed to feel if I overdose?

        Also what do you think of Nattokinase enzyme? Do you think it is worth supplementing for general health or when dealing with infections?

        • If you don’t feel anything, that’s good. Just be alert to see if you notice anything.

          I am not really a fan of enzyme supplements for general health. We evolved proteins for a reason and we don’t want to cleave them with supplements. If you have dysbiosis it might make sense as a treatment.

  20. I’m curious what symptoms or side-effects you notice from too much?

  21. Paul, I have ongoing skin issues and wondered if you might have some thoughts about them. The main issues are eczema and dryness. My hands are especially dry, and the skin appears loose and wrinkly, and kind of looks like snake skin. The same is true of my legs to an extent. I’m in my early 50’s so age is part of it, but if you looked just at my hands you would probably guess that I’m in my late 60’s at least. I’ve been on the PHD for approximately a year now, and cutting out wheat has helped the eczema quite a bit, but not the dry / snake-like skin. I still get eczema a bit, and I think the culprit is either eggs or sweet potatoes, so I’ll try cutting them out for a while and then adding one of them back in. Is there anything else I can supplement or avoid to improve skin health? Since skin is out largest organ, it seems as though it would be a concern if it’s not healthy.


    • Hi Frank,

      I think you have to experiment. Some possibilities:

      – Nutrients. Bone and joint broth, eating skin itself (chicken feet, pork rinds, etc), vitamin C (take to near bowel tolerance), biotin, sulfur are possibly helpful nutrients.

      – Polyunsaturated fats and oxidative stress. Sometimes if you have infections or other sources of immune activity you can deplete polyunsaturated fat levels which affects the skin. Try eating extra PUFA and see if your skin improves; egg yolks are a good omega-6 source and salmon a good omega-3. Also, antioxidants like vitamin A may help.

      – Food sensitivities are a possibility so you could try removing things like dairy, eggs, sweet potatoes, nuts, or nightshades as you suggest.

      I would experiment and see if you can find factors that influence it.

  22. Stupid question, are Coconut Oil and MCT Oil the same thing? I’ve been doing the 16 hour fast and every morning I have a shot of coconut oil, and I’m wondering if there is any point to buying some MCT Oil or would that be redundant?


    • Hi Isaac,

      No, they’re not the same; but coconut oil contains some MCT oil (about 58%). Commercial MCT oils which you can buy at Amazon are typically 100% 8-carbon saturated fats and are highly ketogenic, tasteless, and liquid at all normal temperatures. Coconut oil is about half 12-carbon saturated fats, the rest mostly longer saturated fats; it is less ketogenic, has a taste, and solidifies at 76 F.

      So reasons to buy MCT oil might be that you want to achieve ketosis eating less oil; that you don’t like the taste of coconut oil or milk; that you want to have a flavorless liquid oil for, say, a homemade mayonnaise or other cooking experiment.

      • Liquid at room temperature was all I needed to know, I’m sick of scraping coconut oil into a glass and microwaving it every morning.

        The other points sound great too, thanks Paul!

  23. Fascinating site! I can follow most of your recommendations, but have been a “pescetarian” for 43 years and can’t start eating beef, bone broth, etc. now! What are my alternatives?

    • Hi Nell,

      It’s easy to be a PHD pescetarian. Make fish soups and stews with whole fish to get the bone/collagen material that we recommend bone broth for. You may need to supplement copper given the lack of beef liver; and be sure to eat egg yolks too. Otherwise it’s pretty much the same, just use fish for your meat.

  24. Great! Thanks so much for the prompt reply!

  25. Hi Paul, my doctor does not seem to know what a SIBO test is. Can I get a SIBO test without a doctor? If not, how would I go about searching for a doctor who can?

  26. One more quick question — Why no legumes? No tofu? I don’t eat that much of them, but curious why they are excluded.

  27. Paul,

    Couple of questions.
    Intermitten Fasting within 8 hour window to cure circadian rhythm. Can you still eat coconut/MCT oil during 16 hours?
    I have started my iodine at 225mg. I do eat 2 eggs daily and liver once a week. Would I need extra selenium? or would I need extra selenium if I reach 1g of Iodine?
    Also there only thing I do not have is the Biotin? Can I get this from food and what are possible defficiencies if I do not.

  28. Paul, have you seen this Oxalate resource?
    just another reason to fear vegetables!

  29. Paul,

    I know you do not suggest taking Krill oil in capsules but just out of curiosity, I am looking at consistency and for two capsules I see you get
    Phospholipids-400 mg **
    Eicosapentaenoic Acid (EPA)-100 mg **
    Docosahexaenoic (DHA)-55 mg **
    Omega-6 fatty acids -approx. 20 mg

    Isnt it insignificant amount EPA/DHA? Why is it being advertised as being more effective than fish oil? Are there other benefits from Phospholipids?

  30. Hi Paul,

    I am 31, 5.83 feet and 171.16.

    I workout 2/3 times per week, mainly doing resistance training.

    I did one month on a VLC/Keto diet. During that time, my FBS were pretty good : steady at 4.8mmol. Before it used to be around 5 any time I did some blood test.

    The first surprising thing is that my I didn’t experience any weight loss while on keto… My digestion also slowed down seriously.

    On top of it, I also experienced a severe relapse into depression…

    After one month, I found it to much of a cost for no results, and introduced more carbs again. The first few days, I did it in a reefed/backload fashion and ate tons of high GI carbs.

    Since then, my glycemia went out of whack. My mood is also not extraordinary…

    I’ve read about Physiological/Peripheral Insulin Resistance which is supposed to be a normal adaptation while on ketosis. But I read that it is supposed to to go back normal within few days of eating carbs again…

    My blood glucose stayed between 6.5/7 all day long for almost a week.
    Since then my best reading has been 6.1 for FBS and 5.3 during the day.

    On top of it, I gained 6.6Lbs and 0.78inch of waist… All this in 10 days…

    Needless to say, I am bit frustrated !

    I don’t really know where to go from here… You’r advice would be much appreciated.

    Kind regards from Mauritius Island !


    • Hi Marc,

      Well, it’s unfortunate that you had such a bad experience. VLC ketogenic diets are not really weight loss diets — people often do lose weight when they remove whole food categories from their diet, but the diet doesn’t really address the underlying causes of weight gain, so I don’t consider it a treatment for metabolic conditions. We use ketogenic diets mainly as a treatment for neurological conditions.

      VLC ketogenic diets risk flaring certain kinds of infection, mainly eukaryotic infections (fungi, protozoa, parasitic worms). So your experience could have diagnostic value.

      A likely possibility is that some infection flared up in your intestine and pancreas leading to the blood glucose regulation problems and weight gain.

      Are you able to see a doctor and obtain diagnostic testing, eg a stool test like the Metametrix microbial ecology DNA test? That might help identify something to treat.

      As far as diet I would recommend eating according to our food plate. Carbs around 30% of calories, 3/4 lb per day low omega-6 meats and fish, 3 egg yolks a day, bone and joint broth soups, green leafy vegetables. Be sure to get sun exposure and key supplements like vitamin K2 and magnesium.

      Also, the lifestyle and circadian rhythm tactics discussed in our book would be helpful.

      But if you can get a diagnosis of any infections, treatment would provide the quickest route to recovery.

      Best, Paul

      • Thx Paul for such a quick and insightful answer.

        I will ask my doctor if such a test is possible here in Mauritius !

        I will let you know…

        Thx again.


      • Even though ketogenic diets have been the default diet for epilepsy, some doctors are getting equally good results with a low GI, higher carb approach:

        The LGIT allows for an increased intake of carbohydrates, with a typical goal of 40-60 grams per day. Food quantities are not weighed out to the gram, but are based on portion sizes. Because it is based on portion instead of exact measurement, patients are able to live a more flexible lifestyle that includes eating at restaurants. Foods that are the basis for the ketogenic diet and are high in fat, such as heavy cream and high fat meats (bacon, sausage, hot dogs and eggs) are also included in the LGIT. However, on the LGIT the percentage of calories from fat is approximately 60%, compared with up to 90% on the ketogenic diet.


        If epileptics can get the same benefits from this diet as with the classic ketogenic diet, might this not extend to other uses of VLC?

  31. Hi Paul,
    My significant other has mantlecell lymphoma and he just had his last chemotherapy session. He will be getting a ct scan done and then the Dr might put him on a maintenance program of Rituximab every 2 months for 2 years. I read about Vitamin K2 and vit D for cancer patients and would like to know what dose to give him and also I’m confused on the MK-4 and MK-7forms. Currently I’m taking 2 45 mcg capsules of vitamin K-2 (as meaquinone-7) right now. His oncologist (who recommender your diet)says I should be taking a higher dosage. On your supplement page there are several kinds of pills for each supplement. I’m confused on which ones are best.
    Thanks for your advice. Syl

    • Hi Syl,

      For K2, higher is better. You can take pills multiple times a day to space them out, take them with meals. I think a mix of MK-4 and MK-7 is best, but the highest reasonably-priced doses will be in MK-4 which are manufactured synthetically — Carlson makes a 5 mg tablet.

      For D3, you want to get serum 25OHD around 40 ng/ml. That may require around 4000 IU/day in the winter and 2500 IU/day spring and fall, but he should get as much midday sun as possible. In the summer he should get enough sun that he doesn’t need supplements at all.

      I would also do intermittent fasting, eliminate wheat, and circadian rhythm strategies including daily light outdoor physical activity (light = not exhausting), bright lights in daytime and dim lights at night.

  32. Paul-
    I have a friend with health issues and limited funds.I am trying to get him PHD compliant and within his means.Would making bone broth from conventionally raised cows and chickens be acceptable?

    • Hi John,

      I suppose so, although we noticed they didn’t taste as good. However, bones from grassfed cows are cheap, at least in our area; $3/lb. Maybe he can find conventionally raised bones for free.

  33. I think there’s something to that free F.lux program to filter blue light on your computer at night for circadian rhythms. I should try the orange safety glasses.


  34. Hi Paul, what do you think about Acetyl L-Carnitine (ALCAR)? Daily supplementation?

  35. Hi Paul, one more questions for you. There is a very interesting company called trueprotein.com and you can customize your own mix with Protein/Fats and Carbs. The only Fat available is MCT, which is the one you suggest for Keto. I wanted to get a custom mix with 65 fats, 15 protein and 20 carbs. I understand that it should not replace your meals but I think sometimes might be useful. Which proteins and which carbs would you choose there? Also are Glutamine Peptides ok for Fiber?

    Would really appreciate your input.

    • Hi St,

      I don’t really want to endorse a purified macronutrient mix, so I hope you don’t mind if I pass on coming up with a specific recommendation.

      • Paul I completely understand.
        I guess just in terms of protein types for health reasons, I assume Caseinate is not advisable due to auto-immune issues?
        What is the difference and what is the safest from these: Beef Protein Isolate, Egg Protein, Rice protein concentrate?
        Also what about Whey concentrate or Whey Isolate? Is concentrate more nutritious?

  36. Hi Paul,

    I have Hashis and working on healing a leaky gut. Nuts in any way shape or form don’t agree with me. I was eating them for fats mainly until I realized how much they were derailing my digestion. Feeling better without them and on the PHD for automimmune for a while. But without nuts I realize I am not eating enough fats. Most all of my fats are in proteins so I’m eating mostly protein and carbs, like rice, potatoes, eggs and meat. Consequently, I’m starting to lose weight which I don’t need to do. What would you suggest? Is too little fat the problem?

    Thanks. Have a wonderful Thanksgiving!

    • Hi Jan,

      Be sure to get 3 egg yolks a day, some coconut milk, and some butter or sour cream daily. If you choose fatty cuts of meat and make sure everything tastes delicious, you should be getting enough fat.

      If you think you’re well nourished and eating sufficient food, then I’d ask if you are exercising at all and if you find it difficult or easy to gain muscle and strength. If you lift weights once or twice a week, do you get stronger? This would be a good sign that you’re not malnourished and that the weight loss is not unhealthy.

      Another place to look is in micronutrition — do you make bone and joint broths? Supplement vitamin C? Sometimes nutritional deficiencies can lead to weight loss.

      Have a very happy Thanksgiving yourself!

  37. just saw an interesting question over at paleohacks regarding gut bacteria,

    thought it worth linking, on the chance that some PHD readers (and Paul of course) may be able to add to the conversation with some comments/answers and possibly help the user out

    • Interesting for sure, and speaks to my own fear that I set myself up to develop ulcerative colitis which happened after being on a non starchy vegetable, low carb diet for a few years. I sure hope that with time and following PHD that I can get my ‘dysbiosed’ bacteria in balance again.

  38. Hi Paul, 2 food questions…

    How do you rate the harmfulness of Egg Whites on a scale of 1 to 10 (1=not to worry, 10=avoid like the devil)?

    I eat oysters to get my daily zinc. I read that
    1 Oyster = 10 mg Zinc
    but I also read that some can be 40 mg per oyster. Sometimes I eat 5 medium Oysters at a time. Have I been overdosing on Zinc? Is it best to limit 1-2 oysters per day?

    • Hi Monnyica,

      2, hardly worry at all.

      You can easily overdose on zinc. You need extra copper if you eat a lot of zinc. Be sure to get beef or lamb liver or supplement copper 2 mg/day if you’re going to eat a lot of oysters.

  39. Hi Paul, I am having my bone broth with a little veg to quell hunger while fasting till midday. Is that OK? Can I add egg yolk to this or will that stop the fasting process?
    Cheers, Shelley

    • Hi Shelley,

      That’s great, with or without the egg yolk. You don’t want to be too hungry. Mild hunger is fine but don’t stress yourself.

      Yes, cooked egg yolks are fine. Just use gentle cooking methods.

  40. Also, are cooked egg yolks just as good as raw or soft? Assuming no Salmonella of course. We buy organic pasture fed free range which have had no Salmonella etc here in Australia.

  41. hey , just want to know if feeding mashed sweet potatoes everyday to my 6months old babies is detrimental to their health in anyway.they pass out stool about 4 times a day. not loose but paste-like.

    • Hi evey,

      In general I’d say it’s healthy but you don’t want to give too high a dose of any one food. So I would mix it up with white potatoes, Asian sweet potatoes, taro, and other safe starches. But a little every day should be fine.

      • Paul, I have some gut reactions (gas) from eating sweet potato’s. Your article on why they can be troublesome was great. do you have any tips on how to get my gut to a state where it can digest them without any problems? Maybe it needs some healing? I used to be able to eat them fine until a couple of months ago. Weird!

  42. Hi Paul,

    Just read your bone broth recipes. For Ox feet, do you also drain the broth after one hour, put new water and cook 3 more hours?
    Is it safe to say that without vegetables it can last around 1 week in the fridge?
    In regards to marrow bones, I see you can reuse them sort of right? So you would make the broth first week and then use same bones with the vinegar next week to extract more nutrients? Do you freeze the used bones for one week?
    Would 2 tablespoons of vinegar work?

    • Hi St,

      The initial simmer and replace the water is to clean impurities, especially congealed blood, from the bones. I suppose this would be helpful with ox hooves also, but you can go by taste.

      Yes, it should last a week in the fridge. We generally make small enough lots that its gone within 3 days, but this is mainly due to our pot sizes.

      Yes, we re-use the marrow bones. The marrow is gone into the soup in the first round, but the bones are still usable. Adding vinegar in later rounds helps extract calcium and expose collagen.

      No, we don’t freeze used bones, we just keep using them until they have lost significant weight.

      Yes, you don’t need a lot of vinegar.

  43. Hi Paul, I hope you had a pleasant Thanksgiving. I’ve had some weird symptoms that I think may point to poor circulation. Firstly, my hands and feet get cold very easily. Secondly, my hands “fall asleep” very easily. As an example, when lying in bed and holding up my cell phone with both hands, in the time it takes me to set my alarm, my hands will begin to “fall asleep”. Any thoughts?

    • Johnathan,
      Similar symptoms here, usually pinky and ring finger only seems to get that numbness feeling when putting pressure on arm etc….

    • Hi Jonathan,

      Some ideas:

      Cold hands and feet could be Raynaud’s.

      The numbness could be an orthopedic issue such as thoracic outlet syndrome where the bones in the thoracic outlet pinch the blood vessels and nerves feeding the arm. It usually reflects weakness and lack of flexibility in the muscles around the shoulder, and poor posture. Strengthening exercises like push-ups and flexibility exercises like yoga are helpful.

      Have you asked a doctor about it?

  44. Hi Paul,

    Why is protein more important than carbs at breakfast?

    Fruit is a good snack so you can have it any time of day, but generally not at meals.

    Since we recommend intermittent fasting, breakfast if it happens at all is usually a sort of snack, so a banana or such is not out of place. But protein is probably more important than carbs at breakfast. So a boiled egg or two would be better, alone, or with the piece of fruit.

    Carbs later in the day tend to help sleep, so in general we would bias carbs toward the evening rather than the morning.

    Also, there’s the saying, “Eat Breakfast Like a King, Lunch Like a Prince, and Dinner Like a Pauper” and the following alternate view (ancestral sounding) article 4 Reasons To Eat More Calories (And Carbs) At Night, which indicates less early day carbs/calories promotes fat burning.

    It had me wondering how this phrase might map into PHD – “Eat Breakfast like a Pauper, Lunch like a Prince, Dinner like a King”?

    So think of every 24-hour span as two distinct nutritional periods. Eat lighter during the day so you remain in your natural fat-burning, energy production state (hunt mode). During the evening hours, provide your body with the raw ingredients it needs to build and maintain muscle, store energy reserves, recover from the demands of the previous day and prepare for the next one (feast mode).

    Think in terms of being like a caveman during the day. Emphasize lighter meals and snacks based on lean proteins, veggies, whole fruit, and small servings of nuts. Save starches for dinner.

    Then, when night comes, go Japanese village-style. Eat a bigger, satiating dinner based on lean proteins, veggies, and some natural starch foods like yams, potatoes, or rice with servings based on body size and activity levels.

    • Hi Mark,

      Good questions. I’ve seen some evidence favoring carbs at night, I think a sentence and a cite made it into the book on that, but I don’t consider the evidence strong enough to trump following your own taste preferences.

  45. Hi Paul,

    Your site is such a resource to a sickling like me. I’ve dug through the archives and appreciate your expertise and willingness to help others – can’t wait for the book release.

    My metametrix GI just came back with H pylori, fungal (+1), and a parasitic (unknown) infection. Very impaired fat absorption. My doctor also believes my small intestine may be infected in some manner.

    My GI issues were triggered by a flu bug I caught in the colorado mountains and my recovery has been complicated by exposure to biotoxins of massive toxic mold overgrowth discovered in August of my now-former residence.

    Treatment for mycotoxins (Shoemaker protocol) has made my gut more dysfunctional, unfortunately.

    Over the last six months I’ve had to restrict carbs due to hyperglycemia and relfux-induced vocal problems. Lately, I’ve experienced more gut irritation when eating and supplementing with Betaine HCl.

    Beyond GI symptoms I’m experiencing hormonal abnormalities, but these could primarily be the result of poor nourishment.

    Any advice on how to improve nourishment? Or does removing pathogens take precedence?


    • Hi Alex,

      Well, it’s good news that you have found targets to treat.

      I guess I’m not too surprised that the Shoemaker protocol might have caused problems – I think he overdoes the cholestyramine to a level that will depress serum lipids and thereby sabotage immunity — see our posts on the immune functions of LDL and HDL. That may not be an issue if your only problem is environmental mold toxins but if you also have ongoing infections it is an issue.

      I would try to eat as close to PHD as your digestion permits, and see if treating known infections improves matters. I would start with the fungal and parasitic candidates since anti-H pylori treatments can worsen those by removing competition from normal gut flora.

      • Thanks Paul. I look forward to the new edition of the book — I can’t get a copy of the old so I’m waiting still to read. And for a new year for me after many health setbacks in 2012.

  46. Hi Paul,

    I hope you and your family had a nice Thanksgiving holiday. I am a 32 year old female, 5’6″ & 180-185 lbs. I have struggled with my weight since giving birth to twin boys in 2010. I have tried several different measures to feel better and lose weight but still suffering and would like your thoughts, if you don’t mind 🙂

    Depression/Anxiety (I have tracked to be at its worst around ovulation until my period starts), increased high sugar/carb cravings are around this time of the month. I am sad b/c I eat and eat b/c I’m sad. I can become more frustrated, irritable and moody. I have had severe dry scalp, almost looking (and very well could be) psoriasis since giving birth, my acne has increased and I have melasma that appeared after pregnancy. I have worked very hard at trying to lose weight, lost 45 lbs but can not get below 180. I am often bloated with lots of stomach gurgling after eating. I often feel like I could still “go” to the bathroom but only produce 1 bowel movement a day without the help of extra magnesium and vitamin C.

    Measures taken:
    Exercise-4-5x/week, (2 days strength, 2 days yoga/pilates and extra day light cardio).
    Diet-I have done VLC, ketogenic, low calorie and for the last 3 months paleo/PHD. I currently take your recommended supplements and additionally take 30 mil probiotic/day. I have not lost any weight and some symptoms have grown worse (mainly my skin issues and bloating).
    I have had a full blood panel completed in September and I was told my numbers couldn’t be better. Thyroid and all of its associated levels were great, cholesterol/triglycerides in normal range, hormone levels were in the normal range (I even had the test during the time of the month when I exhibit the most symptoms). I thought some of the symptoms were due to having an IUD so I had it removed in January of this year. No change noted since January.

    The goal is to improve my overall health and I know something else is going on that is causing me to not lose weight. I am not sure what other measures to take and wanted to know your thoughts and suggestions. I apologize for the length of this post but wanted to be as detailed as possible for your review.

    Thanks for your time and God bless!

    • I did want to add that while some symptoms grew worse, my mood is less drastic and the sugar binge urges have reduced since following paleo/PHD.

    • Hi Elizabeth,

      The bloating is a sign of some sort of gut dysbiosis or infection, and the weight gain and depression/anxiety are consistent with that. Depression and anxiety are caused by inflammation in the body (circulating cytokines in the body enter the brain and stimulate you to rest and avoid others when you have an infection) and adipose tissue is an immune organ that helps organize a fight against gut infections.

      So I would pursue diagnosis of whatever microbes are in your gut. A good stool test is the Metametrix microbial ecology profile.

      You might also work on circadian rhythm strategies and intermittent fasting, and supplement NAC which is usually helpful against infections.

      Best, Paul

      • Thanks so much for your prompt response! I will look into your suggestions and hopefully see some improvement. I hope you have a nice evening.


  47. How long should one take NAC to improve a possible viral or fungal infection, and does it matter what time of day?
    Thank you!

    • Hi Elyse,

      NAC is best taken while fasting, to help it clear the stomach.

      I think it should help as long as you have the infection. Be sure to eat adequate protein along with it.

      • NAC with protein while fasting? Or, NAC while fasting and then add in the protein after fasting? 500g per day OK?

        • Hi Jonathan,

          Sorry, that was poorly phrased. Adequate protein during meals that day, not immediately alongside the NAC.

          500 mg is OK, sort of a minimal dose but if you don’t know whether it’s helping it’s a good dose. If you know it’s working against your infection then I would recommend more.

  48. Paul,

    Do you have any suggestions for curing casein intolerance/allergies? Is it doable?

    • Hi SC,

      My personal casein intolerance appeared when my gut was unhealthy and disappeared when my gut healed. I had multiple food sensitivities at that time that all went away.

      So yes, I think it can be cured. But there is no universal formula — just pursue general good health and clearing any infections, including gut infections.

      Best, Paul

  49. Any good remedies (dietary or otherwise) for athlete’s foot,
    Or it’s Northern analog, jock itch?

    • Hi David,

      Both improved a lot on PHD and even more when I added iodine supplementation.

      Then I used an anti fungal cream on my feet and since then the athletes foot is gone. I’ve had it for 17 years, tried antifungal cream before but it always came back quickly. Now it looks to be gone so you can imagine my happiness 🙂

      The jock itch is still there sometimes especially when I wear tight pants. I also have toe nail fungus which has improved a lot on PHD but isn’t gone – cream doesn’t help against it.

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