Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. I’m fairly new to the PHD. I haven’t yet read your book because I’m eagerly waiting for the new updated one. I’ve been experimenting with your diet suggestions available on the website now for about 6 weeks. I’ve added bone broth, liver, white rice, sweet potatoe as suggested to my already mostly paleo type diet. I feel good on your diet for the most part.

    There is one issue that is new for me however since I’ve started and I’m not sure what’s causing it. My fingernails have become very thin and fragile, even though I’ve been adding gelatin to my green smoothies. My nails were were not like this before. I get plenty of greens and the only dairy my body seems to tolerate is raw butter and cream, not milk, kefir or yogurt.

    What the heck is causing my nails to weaken since about 9 days ago, and what can I do about it? Any thoughts or suggestions would be greatly appreciated.

  2. Hi, Paul and Shou-Ching.

    I have a confession: I had been eating the PHD-way for a while and feeling well mentally, but continuing to gain weight. Because I have secondary hypothyroidism, I assumed it was because of the dx. But after some time, I went back to my old ways and went low-carb again (<50g), dropped any starches, and upped the fat. I initially lost a few lbs (water) and now have steadily gained even MORE weight. Everyday I seem to weigh more.

    My doc threw me a bone and gave me a half of the smallest dose of T3 to supplement my Armour. Still gaining weight, though it's only been about one month I have been taking this. (I also take bio-identical estrogen and progesterone, but haven't tweaked those doses.)

    I may have actually found a Nurse Practitioner who would agree to test my rT3 along with my fT3. Finally. I had planned on getting labs in about two weeks to see where I'm at with new medication addition, but I'm "jonesing" for a yam (lol). Do you think I should continue my low-carb ways until testing or just go back to PHD and test anyhow? Stupid question, but wanted to see where my levels were at eating this way currently (low-carb).

    Lastly, I've eaten eggs every morning for two years (as meat doesn't sound appealing in the a.m.). I may just vomit if I continue this trend. What are some of the best ways to incorporate more egg YOLKS into your diet? Any direction/suggestions for either topic is so appreciated.

    Thank you again for all the time and attention you pay to your readers/bloggers. Your insight is invaluable.

    • Hi Laura,

      You didn’t say: Are you hungry? Are you eating when not hungry? Are you intermittent fasting?

      I eat egg yolks in my lunch, which is usually rice, meat, vegetables, egg yolks, and some vinegar and coconut milk warmed in the microwave. This is generally my first food of the day, eaten whenever I first get hungry. Usually between 11 am and 3 pm.

      I would generally advise mixing them into meals, just as you would use fat (butter, sour cream, coconut milk or oil) to flavor food.

      • Thanks, Paul!

        Yes, yes, and no. I am hungry often and interpret this as “not enough fat.” Ate more, gained more.

        I am aware I am eating when I’m not truly hungry and know this contributes to my weight gain–yet still feel compelled to eat for some reason (not just boredom; I’m crazy-busy most days).

        I stopped IFing because I had continued to gain weight a while back. Perhaps I will need to reinstitute this again. I was told I may have adrenal issues and that IFing may make things worse.

        Thanks for breakfast/lunch idea! I had read you added egg yolks to yams and tried it a while back. Don’t ask me why it grossed me out, but it did and I didn’t do it again. I will add raw yolks into my meals like fat, as you said. I need to be a big girl and get over the aversion.

        If any of the above info helps, let me know. Thanks again, Paul. Look forward to the new book!

        • Hi Laura,

          Rarely do people get hungry for lack of fat. Usually they have enough stored fat to meet their needs. It’s more often protein or carbs driving hunger, or micronutrients.

          So the only fats you need to emphasize are the nutritious ones, like egg yolks. When hungry it’s usually better to eat a balanced meal with carbs and protein.

          I think IFing is often helpful even if there is a bit of adrenal stress, but eat if you are hungry. If you’re not hungry it may be worth enduring a little adrenal stress.

          I can see egg yolks and yams not being appetizing, but often if the egg yolks go in soup (or with a balanced meal) and are cooked, you hardly notice them.

        • Laura, try making aoili ad upping the yolks in the base, or any mayonnaise. Goes with lots of things…

  3. Paul,

    As I gave up nuts due to O6, my default snack has been cheese.

    It is not that i get hungry and need to eat, but sometimes i just want to eat something.

    What are good “snacks” on PHD? – still waiting for the book release. I do green tea twice a day with a tablespoon of coconut oil and also 2 squares of dark chocolate once a day. But on weekends, being in the house longer I tend to “look” for something to nosh on.


    • Hi Evan,

      Anything on the food plate can be used for snacks.

      My snacks tend to be cherry tomatoes or berries or a boiled egg in the morning, fruit or chocolate in the afternoon, a glass of wine in the evening. If I want anything more it’s usually leftovers.

  4. Paul,

    2 general comments.

    1. Fat America… http://www.zerohedge.com/news/2012-11-24/its-fat-fat-world-after-all-and-what-means-rest-us Perhaps a big audience for your book.

    2. A little on conspiracy theory….. Do you think the US gov’t promotes the low fat diet etc due to the corn and wheat subsidies they dish out as well as the fact that it would be impossible to feed 7 billion (or more) people on 1/2 lb of beef, O3 fish and 3 eggs a day? Easier to feed the masses on corn and grain etc than raising enough cattle and eggs. It just can not be done.

    • Thanks, Evan.

      I don’t think it would be impossible to feed 7 billion a healthy diet. But certainly we might have to spend more of our income on food.

      I do think agricultural subsidy programs have influenced the government’s diet advice. Indeed, Senator George McGovern of South Dakota, chair of the Senate Agriculture Committee, pushed the food plate and lipid hypothesis based in part on excitement over scientific backing for eating corn oil and soybean oil. People like to think that things that make them better off are also good for us.

  5. Hi Paul;

    I’m due for a hydrogen test for SIBO sometime next week.
    I’ve been planning on starting a water fast tomorrow, which I hear is good for bacterial overgrowth. However I wonder if a few days fasting before the test might temporarily diminish the levels of bacteria so my test results read a false negative.

    What do you think?

  6. Hi Paul,

    Just wanted to show you some love. I think it is awesome that you used your health experience to help so many others. Thanks for the help and inspiration my friend!

    Best to you and your family,


    P.S. Looking forward to the new edition

  7. Hi again dr.jaminet. I just read your post on microwave cooking, which you feel is a safe method for cooking food. I am a bit conflicted about the safety of microwaves after reading several articles on dr.mercola’s website expounding on the potential dangers of microwaves.
    It does not seem to be such a big problem that microwaves destroy nutrients, but rather that they alter the molecular structure of nutrients, rendering some nutrients inert (inactivating them) and trasnforming others into carcinogens and mutigens (in fact, microwaves were banned in Russia due to health concerns). Have you explored this at all? Here is a small sampling of studies from dr.mercola’s website –

    • In a study of garlic, as little as 60 seconds of microwave heating was enough to inactivate its allinase, garlic’s principle active ingredient against cancer[7] .
    • A Japanese study by Watanabe showed that just 6 minutes of microwave heating turned 30-40 percent of the B12 in milk into an inert (dead) form[8] . This study has been cited by Dr. Andrew Weil as evidence supporting his concerns about the effects of microwaving. Dr. Weil wrote:
    • “There may be dangers associated with microwaving food… there is a question as to whether microwaving alters protein chemistry in ways that might be harmful.”
    • A recent Australian study[9] showed that microwaves cause a higher degree of “protein unfolding” than conventional heating.
    • Microwaving can destroy the essential disease-fighting agents in breast milk that offer protection for your baby. In 1992, Quan found that microwaved breast milk lost lysozyme activity, antibodies, and fostered the growth of more potentially pathogenic bacteria[10] .
    Quan stated that more damage was done to the milk by microwaving than by other methods of heating, concluding: “Microwaving appears to be contraindicated at high-temperatures, and questions regarding its safety exist even at low temperatures.”
    • Another study about breast milk/infant formula by Lee in 1989[11] found vitamin content becomes depleted by microwaving, and certain amino acids are converted into other substances that are biologically inactive. Some altered amino acids are poisons to the nervous system and kidneys. (Numerous authors mention this study, yet I was unable to find the original article/study, so I cannot personally validate.)

    [7] Song K and Milner J A. “The influence of heating on the anticancer properties of garlic,” Journal of Nutrition 2001;131(3S):1054S-57S
    [8] Watanabe F, Takenaka S, Abe K, Tamura Y, and Nakano Y. J. Agric. Food Chem. Feb 26 1998;46(4):1433-1436
    [9] George D F, Bilek M M, and McKenzie D R. “Non-thermal effects in the microwave induced unfolding of proteins observed by chaperone binding,” Bioelectromagnetics 2008 May;29(4):324-30
    [10] Quan R (et al) “Effects of microwave radiation on anti-infective factors in human milk,” Pediatrics 89(4 part I):667-669.
    [11] Lee L. “Health effects of microwave radiation-microwave ovens,” Lancet December 9, 1989 (Article)

    The article further notes that “Twenty years of Russian research (and German studies as far back as 1942 Berlin) make a strong argument against the safety of microwave cooking.
    Their findings led the Russian government to issue an international warning about possible biological and environmental damage associated with the use of microwave ovens and other similar frequency electronic devices (e.g. mobile phones)”

    • Russian investigators found that carcinogens were formed from the microwaving of nearly all foods tested.
    • The microwaving of milk and grains converted some of the amino acids into carcinogenic substances.
    • Microwaving prepared meats caused the formation of the cancer-causing agents d-Nitrosodienthanolamines.
    • Thawing frozen fruits by microwave converted their glucoside and galactoside fractions into carcinogenic substances.
    • Extremely short exposure of raw, cooked or frozen vegetables converted their plant alkaloids into carcinogens.
    • Carcinogenic free radicals were formed in microwaved plants—especially root vegetables.
    • Structural degradation leading to decreased food value was found to be 60 to 90 percent overall for all foods tested, with significant decreases in bioavailability of B complex vitamins, vitamins C and E, essential minerals, and lipotropics (substances that prevent abnormal accumulation of fat).

    The Swiss Clinical Study: Hans Hertel
    Some fairly compelling evidence supporting the destructive effects of microwaves comes from a highly cited study by a Swiss food scientist named Hans Hertel. Dr. Hertel was the first scientist to study the effects of microwaved foods on the blood and physiology of human beings.
    His small study, coauthored by Dr. Bernard Blanc of the Swiss Federal Institute of Technology and the University Institute for Biochemistry, revealed the degenerative forces produced by microwave ovens on the foods they cooked.
    Dr. Hertel concluded that microwave cooking changed the nutrients in the food, and that changes took place in the blood that could cause negative health effects.
    Hertel’s conclusions were that microwaving food resulted in:
    • Increased cholesterol levels
    • Decreased numbers of leukocytes (white blood cells), which can suggest poisoning
    • Decreased numbers of red blood cells
    • Production of radiolytic compounds
    • Decreased hemoglobin levels, which could indicate anemia
    Not surprisingly, Dr. Hertel’s study was met with great resistance from those with much to lose.
    A gag order against Dr. Hertel was issued by a Swiss trade organization in 1992, which was later removed in 1998. But an American journalist, Tom Valentine, published the results of Hertel’s study in Search for Health in the spring of 1992[15] .

    [15] “Microwave ovens: A danger to your health?” (January 26, 2010) Nutritional and Physical Regeneration

    • Hi Marcus,

      Well, I don’t find those studies persuasive. Offhand they seem to conflate the effects of heat/cooking and the effects of food with the effects of microwaves; we would also have to look at the energy levels. As far as I can tell, no controlled study has found damaging effects of normal microwave cooking.

      • I guess the problem is that we no longer have easy access to the studies done by Russia, but they were apparently persuasive enough for Russia to issue a national ban on microwave cooking and an international warning against their use.
        Its true that most studies don

        • More likely a ban on them was to cover up that they were unavailable.

        • More likely a ban on them was to cover up that they were unavailable. 🙄

          • unlikely. Russia has always been proactive at protecting public health and it makes no sense that they would research microwave cooking more extensively than any other country if they didn’t even have access to them. Russia is very ahead of the curve with biophysics research. It just seems like common sense to me that using radiation, which is known to be mutagenic, to cook food is counterintuitive.

      • It’s true that most studies don’t find any harmful effects to microwave cooking, but then I guess it depends on what the experimenters are looking for. Generally they are only looking for the survival of nutrients and not the presence of carcinogens or signs of blood poisoning.
        i’m not aware of any other cooking method producing so many carcinogens (except maybe deep frying or char grilling) so i’m not sure what you mean but ‘conflate the effects of heat/cooking with the effects of microwaves. I’m also not aware of any cooking method which shows signs of blood poisoning (and the gag order suggests they are hiding something).
        Each to his own, personally I consider the safety of cooking food with high levels of radiation to be very dubious on instinct.

        • microwaves are not ionizing radiation; their energy is channeled into vibrating chemical bonds, which produces heat. The energy is similar to that supplied by boiling in water. No DNA is harmed by the application of the microwave energy produced by a commercial microwave oven.

          On the other hand, Michio Kushi hated them, saying, “Give a microwave to your worst enemy.” – said while chain smoking.

  8. The scuttlebutt was, 35 years ago, that microwaves were illegal in Russia because their studies showed a 60% loss in overall nutritional value. You might direct your searches in Russian!! I know the science behind it but if there is science we don’t yet understand then we can’t really comment on what we don’t know. When in doubt….??

  9. Hey there,

    I’m a music student and physics professor. After much research, I have decided to go paleo. Another thing that I aim to do is to eat mostly the same thing every day so that I don’t have to waste time thinking about what I’ll be eating today, what I need to buy etc. You might be saying, “Won’t that get boring?” To put it in perspective I’ve been eating the same breakfast and lunch for the past 10 years. I eat food for sustenance and not pleasure so, no, it isn’t boring because I’m looking for efficiency. On the weekends, I can venture into soups and other things because I would have time but weekdays…

    I’ve made a daily meal plan and was wondering what your thoughts on it were.

    Before breakfast: glass of water with juice of 1 lemon; 1 hour of yoga.
    Breakfast: Omlette (2 eggs, mushroom, 1/4 red/yellow bell pepper, 1 spring onions, spinach, 1/2 cup zuchini), with a drop of olive oil
    Lunch: Baked potato (alternate between regular white and sweet potatoes), steamed veggies (pepper, cucumber, broccoli, carrots, fresh beet, asparagus) and a filet of salmon, pan seared with a drop of olive oil (liver once a week)
    Dinner: 2/3 cup quinoa or rice, raw veggies (pepper, olives, tomatoes, lettuce, spring mix, broccoli, avocado), a thumb of feta cheese
    -Snacks throughout the day: Munch a lot of celery, fruits (apple, banana, berries, oranges, etc), one cube of dark chocolate a day, one glass of red wine ever other day day, a handful of nuts a day

    What are your thoughts? Is this enough for everything I need?



    • Hi Val,

      It’s pretty good. I don’t agree with eating salmon every day because that would provide too much omega-3; if you can mix it up with beef/lamb and less oily fish and shellfish that would be better. I think nutritionally you could stand to get more egg yolks, shellfish, bone or joint broth (make it on the weekend and have the same lunch or dinner but with soup broth over it), and seaweed. We also as a rule recommend intermittent fasting, which tends to reduce the number of meals to 2, with limited snacks. But it’s not obligatory.

      Best, Paul

    • Hi Val,

      This is an interesting meal plan, thanks for sharing.

      Some things that came to mind for me are that it might be low in calcium, selenium, zinc – I suspect a nutrition calculator like http://cronometer.com would reveal that. Probably need to add a serving of meat/seafood. At least I find 8 oz meat/seafood plus three eggs daily to be a little low according to nutrition calculators.

      I think Paul’s suggestions will get you there.

      Also noting that
      Quinoa is not officially PHD approved and it appears to be a staple of your meal plan.

      Assuming you’re also following the Recommended Supplements.

  10. Hi Paul,

    If one has been cooking with O6 oils for years, does this not make getting Vit.D via sun exposure a bad idea?

  11. Hi Paul,
    Love the book. On a few podcasts I’ve heard you mention that modern mineral deficiencies may be partly due to water treatment reducing minerals in water, and that mineral water would be a good way to get more minerals. Just wondering, what is your opinion of the Trace Minerals Research Concentrace product?

    I use it a fair bit (10-15 drops per glass); since using it I find water tastes too ’empty’ without it. My dental health definitely improved since using it although there were plenty of other diet-related changes at the same time that may have accounted for that.

  12. Hi Paul,

    I’ve been eating a paleo diet for a year and a half now, but within the last few months started to find it very difficult to maintain the VLC (meals just got harder and harder to choke down without carbs). I struggled with symptoms of hypoglycemia before beginning paleo, and these went away a few months after I began the diet. However, now that I’ve begun PHD and added more potato and rice to my diet, I’ve noticed more and more hypoglycemia symptoms: shaking, flushing feeling, anxiety and chills, only now they begin very shortly after eating a meal on days that otherwise feel great and normal. I thought it might be a spike in blood sugar but I always combine fat with my carbs, and occasionally experience these symptoms after eating only coconut oil in a cup of tea. My naturopathic friends seem to think this is indicative of some kind of “healing crisis” but I’m not convinced. Any idea what could be causing such a reaction, and do you think healing reactions in this type of situation are likely to occur?


    • Hi Tiffany,

      I believe this usually indicates some sort of gut infection. Your body needs carbs, but they also feed the microbes leading to impaired metabolic regulation.

      I would try diagnostic steps like a stool test. Also you may find that things that improve digestive function, like betaine hydrochloride with meals to increase stomach acid or digestive enzymes or vitamin C and taurine to promote bile flow or thoroughly chewing your food, are helpful.

      Best, Paul

      • Thanks for the quick reply, Paul. Do you suggest modifying the PHD if a gut infection is present? I know you mention several times in your book that the PHD is intended to reduce pathogens.

        • Yes, you might modify it somewhat to minimize symptoms — find carb sources that cause the least trouble, reduces carbs somewhat, things like that. Keeping in mind that big deviations may suppress immune function or cause malnutrition leading to long-term problems.

    • Tiffany,

      Have you tested your blood sugar post meals. It might be wise to see what is going on there so you will know for sure rather than speculate. Try the series of tests Chris Kresser recommends.



  13. I am intrigued by your take on things. I have been eating paleo, more or less, for over 4 years and I have per-ordered your book for my kindle- can’t wait.

    I have a question that affects many people. A close friend gave up alcohol over 2 years ago after drinking heavily for years. She is and was in good health, by the conventional numbers. She considered herself an alcoholic and is very pleased not to be drinking. She now finds herself craving sugar more than she ever did in the past. I have found the same thing in virtually everyone in her group. It would seem that sugar has replaced the alcohol as an addiction and mood altering food.

    She is naturally slender although she has gained some weight. She feels bloated and constipation as well so I believe her gut flora is out of whack although probiotics have not helped so far.

    I know that this is a common problem, but I am wondering what special considerations there may be in addressing this problem. What isnthe best approach to heal the damage that is leading to this? Most alcoholics find sugar addiction much less damaging, but I remain concerned about the long term consequences and my friend does not feel good with this sugar addiction. I may very well buy a hard copy of your book for her.

    Thank you so much for your research and this forum.

  14. here’s an interview with a smart guy (self-styled, but I have read his books, and he is quite the the intellectual) who claims to follow a “paleo” diet, including intermittent fasting…by the way, his first book (“Fooled by Randomness”) is his best, in my opinion.


  15. Hi Paul,

    I tend to drink one protein Shake a day from grass fed whey. What do you usually add to get some fiber in there? Would half a cup of blueberries be enough? What do you think of just a tablespoon of inulin?
    Also can I just add coconut flour, I see it has tons of fiber? or does it have to be cooked?

    • Hi St,

      I don’t drink protein shakes — I get protein from meat and fish.

      But I would favor adding foods for fiber. Blueberries are great. Coconut is fine. While coconut should be cooked at some point before eating, most producers will have done this for you: http://www.tropicaltraditions.com/raw_dried_coconut.htm.

      • Thanks Paul. That is the one I have actually. It does say, “Tropical Traditions organic coconut flour also contains over 19% non-gluten protein! Therefore, it makes an excellent addition to shakes and smoothies where fiber and protein are needed. Or simply dissolve a spoonful in water as a high-fiber drink with a coconut flavor! This organic coconut flour is very versatile and very tasty. Sprinkle it over your favorite dishes to add a wonderful coconut flavor, use it as a thickener in soups and sauces – the possibilities are endless!”

  16. Dear Paul, we are both very happy with changing our nutrition to Paleo/Perfect Health and adopting Intermittant fasting without problems. Now after getting through the Fructose part in your book i was wondering about the build up of our first meal after 16hours. We use to eat each three eggs in ghee and sometimes selfmade bread with almond flour and often sheep/goat cheese and a shake of heavy cream, coconut oil/ a banana, a hand of frozen raspberries and half of a n apple. After hearing that fructose is reacting with polyunsaturated fats i try now to drink the shake first and eat the rest later. in order to take care of the fructose load-how much time is sufficient to wait before eating the other things? or does it maybe not matter…Thank you, Gregor

  17. Paul,
    Magnesium supplements seem to interfere with my sleep – I might sleep for 4 or 5 hours and then wake up, unable to really get back to sleep (other than brief half-asleep interludes, semi-awake dreams, disturbed dozing, etc.) However a combo “CalMag” powder I used a while back seemed to aid sleep. I stopped taking it because of concerns about excessive calcium supplementation. It’s odd to me because an online search shows tons of articles about magnesium aiding sleep, no mention of sleep disruption. My diet may be a little deficient in calcium, but not extremely so.

    • Hi Tim,

      Well, calcium does help support sleep. See eg http://www.medicalnewstoday.com/releases/163169.php.

      Also calcium-magnesium balance is important, so although magnesium normally aids sleep, if calcium is low then extra magnesium might impair sleep.

      There could be issues with other electrolytes too; low potassium or sodium might aggravate the effects of a low calcium:magnesium ratio. Both conditions are fairly common on low carb diets.

  18. Hi Paul,

    Your diet is working brilliantly for me and my family. I think you and Shou-Ching really figured it out. I have already ordered the new edition for myself and for quite a few members of my extended family. I really can’t wait to share your work with my family.

    I have one question — I started taking NAC after reading about it here and elsewhere because I caught a sinus infection that my son brought home from nursery school several years ago. The symptoms will go away for a while and then come back. The chief symptom has a fog in my brain that will last for a month and then ease again.

    What I found, interestingly, was that while NAC did not totally “cure” me of the brain fog, it did dramatically help it and it reduced my anxiety, which has been bad on and off since I got the sinus thing. Should I keep supplementing with the NAC for general support? Does this sound bacterial or viral to you? Do you think that the sinus problem could be responsible for mild hypothyroid symptoms? I also noticed that a couple of days after I began NAC I was not cold or sensitive to light for the first time in as long as I could remember. Total miracle!

    I weigh 125 lbs — how much NAC should I take? I’m at 600 mg once a day in the morning and wonder if a higher dose would be more therapeutic?

    Thank you Paul and my sincere thanks to you and Shou-Ching for your work.

    • Hi Kristen,

      That’s an interesting experience, but it’s a little hard to tell exactly what’s going on. The NAC supports general immune function; it can also have some direct antimicrobial activities. I’d say it’s more likely to be bacterial or fungal than viral, but I don’t know that for sure. Yes, I think chronic infections are the most common cause of hypothyroidism. Hypothyroidism was almost the foremost symptom of my chronic fungal infection.

      Since it’s working for you, I think you could continue the 600 mg/day or increase it to two a day. Yes, the higher dose can be more therapeutic, but higher doses can be mucolytic and can cause digestive issues, so you want to find the right dose that works best for you.

      • Thanks, Paul.

        I had wondered if it might be fungal because my health improved so dramatically when I added starches back into my diet. I got the first yeast infection of my life from VLC, as well as a rash on my hands, and that experience led me to your work — I was looking for (still) paleo alternatives. Maybe my sinus experience is that last bit of the puzzle to be fixed after my experience with VLC dieting (ugh!).

        Follwoing the PHD diet has left me with zero digestive symptoms, would a Metametrix test still be the best way to detect a fungal infection if it is in the sinuses?

        Thank you!

        • Hi Kristen,

          The Metametrix test may detect a fungal infection, but I don’t think it’s foolproof at it.

          Unfortunately there are few good tests. There are some antibody tests, but they’re not considered reliable. Great Plains recommends organic acids testing (http://www.greatplainslaboratory.com/home/eng/full_oat.asp). I don’t really know what’s best — I’m tempted to say try treating a fungal infection and see if symptoms improve, but doctors rarely support that.

        • Hi Kristen,

          Your post leapt out at me because it I’ve noticed that about NAC too. I take 2.4g of NAC a day, and it definitely has some sort of anti-anxiety effect on me, although it is not 100% effective. I’ve tried finding out more about this but experiences vary so much from person to person. For whatever reason, bone broth has a pronounced anti-anxiety effect on me as well. And as good as NAC and bone broth are, fasting is even better for anxiety in my experience.

          • Thomas, I have noticed the same thing about bone broth and fasting. A few friends have said “wow you eat a lot of soup.” 😉

      • Paul, should we be taking NAC on an empty stomach?

        • I would also like to know if NAC can be taken for an indefinite period of time like any daily vitamin, or just a short period of time like a few months?

  19. Hey mr jaminet, Iv been doing well since adding back safe starches to a low carb diet. Recently I came across Matt stone and his blog and read through his material about metabolism, but I seem to be more confused now. My main issues have been acne and being overweight, I remember before when I used to eat anything and everything I didn’t have any signs of acne, bloating and slow wound healing. But since going paleo, now when I eat wheat or dairy or sugar I seem to get acne flare ups and not feel well, which I didn’t way before I got into the whole healthy eating journey and was eating junk, which frustrates me. My question would be , is avoiding all these foods just making me more hypersensitive to them? And why is it that some people eat all these foods and don’t have acne and others do . Your guidance is much appreciated !

    • Hi Jessica,

      You may have lost or altered the mix of gut bacteria during your low carb period.

      It’s not really known why some people are sensitive to them; a leaky gut can figure in, also incomplete digestion due to lack of stomach acid or some similar cause – these conditions allow partially digested peptides to enter the body, causing an immune reaction.

      I wouldn’t say that avoiding them by itself makes you hypersensitive. I don’t seem to be sensitive to them and I avoid them for the most part — I have wheat maybe 3 times a year, sugar more often but not routinely. Keep in mind also that these foods can be harmful even in people who don’t notice any negative effects.

      • Thanks, that clarifies things a lot and makes me realise the right direction on things. I know you recommend charcoal as a detox aid but doesn’t it also affect iodine levels in the body as Iv read in some places, or maybe other supplements. I’m a bit confused as to when and how to take the supplements, timing, with some fat for better digestion, before or after food, charcoal a few hours away from the supplements etc etc ? Cannot wait for the book, Im getting copies for all my relatives and am looking forward to some positive familial changes as our view on health has been so skewed ! 🙂

        • Hi Jessica,

          Those detox aids can induce malnourishment, so they are not for general use. Actually I prefer bentonite clay to charcoal, it’s what animals eat to deal with, eg, parasitic infections.

  20. Is discussion of alcohol a third rail here?

    When many people end their alcohol addiction, they often turn to a sugar addiction. Apparently there is evidence that those who are attracted most to sweet tastes are more likely to develop an alcohol addiction. This would seem to suggest a physiologic basis for the association between the two addictions.

    So are there any special guidelines or suggestions for those people who were at one time ingesting larger quantities of alcohol, and who are now ingesting large amounts of sugar? Apart from psychological issues, how does one support, by diet and supplements, the reduction of a sugar addiction after ending an alcohol addiction?

    • Hi John,

      The first guideline is to switch to starch. Many low-carbers who switched to PHD, increasing their starch consumption, found that their desire for alcohol or sugar went away. See our Reader Results page.

      I suspect supplements may be helpful also. I agree that the issue is physiological, and that alcohol and sugar seem to be close substitutes for at least some people under some circumstances.

      • Thanks for your response Paul. I can see that perhaps my low carb diet is not always the way to go. As I indicated above, I am very interested in your approach. I will plunge in when I get the kindle version.

        You are very generous here with your posts to answer questions. I am really looking forward to the changes I see trying your approach after my paleo – low carb period. I don’t have sugar or alcohol cravings myself, but I am certainly craving some starch and more realistic levels of those as per PHD will encourage me to consume healthier starches.

        I am also surprised how little I eat – one meal per day almost every day with some snacks before and after yet my weight has plateaued about 10 pounds more than it should be – sub-cutaneous fat largely – not belly.

        Thank you again!

  21. Hi Paul,

    Have you ever heard of Accesa Labs? Do you know if this is a scam/legit?


    The website states that they allow Metametrix testing without a doctor’s note (they have there own doctors that sign off on it).

    • Hi Monnyica,

      I have no reason to consider them a scam. However, it seems like the markups are significant – I believe the microbes panel for which they charge $370 costs clinicians about $170, so they are charging an extra $200 to help you get it. It might be possible to get it cheaper elsewhere.

  22. Well the time off of thyroid meds was short lived. I had low iron (causing heart palps when taking nature throid) so am supplementing iron and taking thyroid meds up slowly. Wondering if you can send me in the right direction though. I have 98.1- 99.1 temps in the morning but stable temps mid day of 98.5-98.7 EVERY day. How can I be SO hypothyroid (gained 8 pounds in less than two weeks since going off thyroid meds!!! I have never gained weight like that before in all the years I have been hypo) and have such low free labs and a normal temp? I understand 99.1 isn’t normal but I am always above 98.1 and NEVER in the hypo range and I am MOST certainly not hyper. I tried to consult with Dr. Rinds temperature graph but i don’t fit ANY of the profiles. I sleep great and don’t believe its adrenal issues. Need a reputable temperature source to read up on or some ideas. Thanks so much. 😕

  23. Paul,

    Here’s my dilemma . I started on your IF recs about a week ago after doing regular PHD for a while. I have coffee with organic cream early and then go until around 11am when I have a “brunch”. Usually grassfed meat or egg yolks, Japanese yam with ghee, greens of some kind. As a snack mid-PM I might have 1/2 banana or apple slices, raw cheese. Dinner around 5:45 is fish or meat, rice, veggies. That’s it. So 2 meals, safe starches, protein, veggies/fruit. I have gained 2 pounds and my blood sugar in the morning is up to 100. On VLC, AM sugar is always in the 80s. never had a problem, not diabetic. I take my sugar periodically to be sure I am not spiking and to see how diet and foods affect my blood sugar. I was very surprised to see my sugar that high today. I can only say that rice and potatoes have come back in and blood sugar is up. Is that a fair conclusion? Could it be due to just 2 meals?

    Thanks. 🙂

    • Hi Jan,

      I’m not sure, it’s puzzling. A morning blood sugar of 100 is not necessarily bad, but it suggests some insulin resistance, which suggests a calorie excess. You don’t say what the quantities of cream and ghee are; or if the blood sugar is before or after the coffee with cream.

      You might want to experiment with a small breakfast that is balanced — say, a banana and egg, or two eggs; or berries and whole milk yogurt — to see if that relieves the high blood glucose. Getting some carbs and protein will help eliminate the dawn phenomenon, http://en.wikipedia.org/wiki/Dawn_phenomenon.

      Normally, including more starches in the diet would lead to lower fasting glucose. It could be that a week isn’t long enough to adapt, or that something else is going on.

      Also, some micronutrients are needed for good glycemic regulation, so it’s worth following our supplement recommendations.

      • Thanks Paul. I did take my blood sugar before eating anything. My cream use is at 8am once a day and about 2 tbsps.

        Yesterday, I ate 2 meals but no safe starches, just meat, veggies, raw cheese and 1/2 apple slices snack. Last meal at 5:30pm. At 7 AM today my glucose was 94. My feeling is I’m very carb sensitive and will need to be cautious about portion sizes.

        Other than IF, the carb limit kind of takes me back to pre-PHD eating, paleo style. I do take the supplements on the new PHD recs and have the new book ordered. I appreciate your input. 🙂

  24. H.Pylori update…Want to share the latest. When I was convinced the HP was not eradicated (severe mid-back pain from morning to night – caught my reflection in a full length mirror and I was stooped in pain like a very elderly lady). The following morning I began what my doc suggested (since I ranted to him that I was certain the HP was not gone), Interfase Plus and Undecylex. I was taking half the prescribed dose of each (2 Interfase 2X a day with 1 of the Undecylex 2X a day), as directed by my doc, with the plan to increase gradually over the first week to 4 and 2 two times a day. After 3 days of this half dosage of each, I answered nature’s call while at work. (Warning…the following is a description of what I saw in the toilet. The squeamish should stop reading. Being a biology major, I am not at all squeamish.) What I saw was memorable. Large – half inch to one inch in diameter – round and oval chunks imbedded in the regular stuff. The best analogy is to say that it resembled a miniature pinto pony, or spotted guinea pig. This had just come out of my body and, again, having a great interest in biology I would have done everything possible to retrieve a specimen of these white chunks (don’t be too grossed out, I would have used a hand covering or some tool), but the automatic flusher promptly kicked in and the stuff was swept out of view in only a few seconds.
    Aghast, I just stood and contemplated what I had just seen. Then, I thought of the “ever present” patch of fattiness, an irregular oval about 4 inches in diameter, just below my right rib cage. I first noticed this when in a doc’s office ten years ago. I asked this ND what this strange swelling was and she readily dismissed it as “nothing.” I never think of it unless I am in the midst of dressing and catch my reflection in the mirror. I’m of average build and not at all overweight, so this was quite visible. Well, this past Monday I stepped to the mirror in this public restroom and lifted my top to examine my belly. Certainly, the patch of fattiness was still visible but when I rubbed my hand over it, it was pronouncedly smaller, without the underlying substance it had before. When I stood up very, very straight and stretched my skin, this shadow of what was, disappeared completely. I did run grab my cell and snapped a photo to show my doc. It was still very visible but is somewhat better now. Likely this imprint will remain for years to come after having been stretched over the underlying structure for so many years.
    I believe this “fattiness” was a biofilm and, at least, partly responsible for the recurrence of HP every time I stopped the SF734. The ND who dismissed it with ease was so problematic in many ways during that visit to her office that I never went back to her, but am now highly motivated to write her a letter. Just for your entertainment I will share that in addition to not recognizing a very obvious disturbance in my body, she measured my height as 5’4” (a height I have not been since I was something like 12 years old – I have been 5’6” all my life since my teen years), and most offensive of all, she told me the issue we needed to discuss was the matter of my drinking. Incredulous, I asked, “MY drinking?” With a look of derision she nodded. I told her that 5 glasses of wine a year would be a heavy drinking year for me and that I had never had a drinking problem. She replied, “If you’re going to lie about it I can’t help you!” I took this bit to another doc and he said she was looking at the wrong number and “must have been having a bad day,” for the elevated liver number was not anything to be concerned about; tested me again and it was normal.
    So, this past Tuesday I noticed much smaller chips of the white stuff and now wish that I had undertaken the process of fishing out a couple, just to see its consistency. I figure it would have been composed of primarily calcium, magnesium, and iron. I am a grandma and have diligently heeded the dubious counsel to take my 1200/600 mg of cal/mag and am always a bit low in iron.
    I will continue with the Interfase Plus and Undecylex, along with the evening dose of Biotagen (prebiotic) and the Ther-Biotic Complete Powder (probiotic) for the three weeks my doc prescribed. I can’t do the VSL that Amy King used because I am sensitive to an additive in it.
    This past Wednesday I awoke with intensely itching eyes (this problem had disappeared back in August, 3 days into my SF734 treatment. I suspect the demolished biofilm released a horde of HP and they, along with their toxins, are migrating to my small intestine and seeping through my leaky gut, exciting my immune system. Thursday morning was just as bad, but yesterday and today have been somewhat better.
    In addition, I’ve ordered Dr. Ettinger’s other products, along with 2 jars of the Manuka Honey and glutamine. I will do my doc the favor of continuing his protocol and will follow up with Dr. E’s program as maintenance through January.
    The upshot? Read Amy King’s HP blog – print it up, read it and get her WHOLE story, then read what Dr. Ettinger has to say – especially about the problem of biofilms. I’ll post again when all is done. My primary hope is that there will be no recurrence of the horrible back pain, but also hope that the irregularities on my tongue and my fingernail ridges will improve. These are supposed to be associated with B12 deficiency, and HP has been hijacking my B12 for many, many years.
    Have had home computer issues these past several weeks, so have been away from PHD. I hope my staying power to write this is appreciated by anyone trying to figure out this turmoil.

    I’m very excited about my ten books coming sometime this month. Congrats to Paul and Shou-Ching.

    • Hi Lana,

      Thank you for sharing your story. Very interesting. Are you sure the white chunks are inorganic? I wonder what a stool test would show.

      It’s great that that swollen spot is shrinking, I think that’s a sign you’re getting rid of something infectious.

      Best of luck and thank you for your support!

      • I suppose it did contain organisms and remnants of organisms. In the moments it was in view, it appeared starkly white. It’s just too bad this happened at school where our hi-tech toilet usurped my ability to take what was mine. I truly would have taken a sample to my doc. I see no evidence of this Tuesday, however.

        • Hi Lana,

          You might ask for the Metametrix DNA stool test, and find out what organisms you have in your stool.

          • I did the gi effects function profile in July, results were h.pylori, ingested fungus, and non-human parasite.

          • Good that you had the test. The white stuff might be the parasite.

            I would try to treat the parasite and fungus rather than the H pylori. Antibiotics for the H pylori will kill your probiotic bacteria which will help the parasites and fungi grow.

    • Lana, thanks for sharing, riveting stuff! (Glad it wasn’t me though 😉 )

  25. Lana can you provide a link for Amy King?

  26. Hi Paul,

    I’ve got another question for ya.

    I eliminated veggies for 3 days, and increased to 2 serving of fruit per day. I noticed improvements: no more gas/bloating, no more acidic/warm stomach. However, I still have bowel movement once a week, and white/yellow coated tongue.

    Was it just coincidental? Or did the removal of fiber from veggies perhaps starve gut pathogens? Odd thing is that I reintroduced veggies (after 3 days) and I am still free of gas and acidic stomach.

    Also, what can I conclude from this (re: SIBO/Candida/etc)? Can I dismiss SIBO? I’m about to email my doctor for a stool test, and I’m wondering based on these recent improvements/remaining symptoms, do I need a Hydrogen Breath test?

    • Hi Monnyica,

      It sounds more like a fungal infection than SIBO, due to the thrush; if so there may be an infection in the small intestine but it wouldn’t be bacterial.

      I’m not sure that we can infer much from the difference in response to veggies vs fruit. It might be coincidence. It could be you were too low carb and the fruit added carbs. Or maybe the specific veggies you were eating had some harmful compound.

      I’m not sure what tests would be helpful. Your doctor can guide you.

    • Hi Paul,
      Looks like I spoke to soon. Gas and acidic stomach returned.

      I’ve been reading about Oral Thrush/Candida and looking at photos. I read the following in forums. Would you agree or disagree with the following?

      -White tongue as everyone refers to in the case of oral candida(oral thrush) is a very thick white coating over an irritated red tongue that is almost painful to get rid of…it stays there all day unless you treat it! Normally,After a night of sleep the tongue accumulates bacterias (as you also do on the teeth because of decreased saliva) which accumulates as a thin white layer and that normally disappears with tooth brushing… There is a huge difference between the too!

      -As a note: you have to be very immunosupressed(read: very sick) with candida albican to get real oral thrush…and trust me it hurts…you can’t scrape it out of your tongue because it is too painful!

      -Yeah, most people on here who think they have thrush is really just a white tongue due to accumulated toxins. Like the poster above said, thrush is painful.

      • Hi Monnyica,

        Of course “scraping it out” is going to be painful, because it’s not on your tongue, it’s in it. I don’t think it’s possible to scrape a fungal infection off your tongue, even if you had infinite pain tolerance.

        But no, it’s possible to get thrush without being severely immunosuppressed, if the infection is sufficiently disseminated. And I don’t think it’s necessarily that painful if you’re not scraping it.

      • Thanks Paul! I have another question. I’m seeing pics of oral thrush as curd-like spots and thick/creamy. Can oral thrush show up as thin films?

        Also, if I can scrape off the “white” layer with my toothbrush, would that argue against thrush (since thrush is not scrape-able)?

  27. Hi Paul,
    What kind of multivitamin do you recommend?

    Is there a multi that will cover the weekly supplements you recommend by taking in smaller amts daily in the multivitamin?

    Can a person get all the iodine they need by eating foods or do they have to take a supplement also?
    Many thanks, Syl

    • Hi Syl,

      We don’t recommend a multi any more. We finally decided they’re just not good for you.

      Yes, you can get enough iodine by eating foods — if you eat shellfish and seaweed.

  28. Hi Paul,
    Is your book out yet?? I believed I preordered it a while ago. Is there anything else I need to do to received it

  29. Paul, do you know of any literature on the subject of hyperglycogenolysis?
    Imagine a state of high blood glucose caused not by gluconeogenesis, but by the excessive breakdown of glycogen stores after meals – instead of increasing fatty acid oxidation, the fasting body uses up glycogen first, leading to hunger.
    This seems to fit with the “metabolic inflexibility” carbohydrate dependency model best, but there is very little – or nothing- about hyperglycogenolysis online except the medical definition.

    An interesting fact about hepatic glycogenolysis; glucose is released from glycogen in the proximal hepatic zone and converted to lactate. The lactate travels to the distal zone and is used for gluconeogenesis before the glucose enters circulation.
    I read this in a paper by K. Jungermann, who is the expert on zonation, but I can’t find it now.
    It’s related to the glucose paradox
    Benefits from the use of lactate as hepatic carbohydrate include not exposing liver to excessive glucose concentrations, supplying energy for glycogenolytic cells at low cost, not interrupting the use of other substrates, not stimulating insulin release.

  30. Hi George,

    Excellent question.

    In diabetic rats glycogenolysis is increased and gluconeogenesis decreased, http://www.ncbi.nlm.nih.gov/pubmed/9541171.

    • A hypothesis; glucose will tend to take over from fat as a substrate given half a chance. Occasionally elevated levels of alternative substrates – either lactate (exercise) or ketones (intermittent fasting or carbohydrate restriction) – lessen the dominance of glucose, allow the use of fatty acids, and protect against metabolic syndrome.
      Alternatively, lactate or ketones are signals to the CNS and genome that more fatty acid oxidation is needed to spare glucose.

  31. While I’m recommending gizmos, this may be of interest.

    You can ferment your own chosen vegetables in this crock, save lots of money and have a much more healthy variety compared to buying unpasteurized sauerkraut or kimchee commercially. And this produces the real deal, with all the beneficial bacteria and lactic acid and nutritional availability of true fermented foods, unlike fake, vinegar based home or commercial pickling/canning.
    I guess earthenware crocks can also sometimes be found at garage sales, etc. too, but I would think you’d have to be careful to find a good one that way, make sure the glaze is safe, etc.
    The gairtopf crocks (there are several sizes available) have a little moat along the top edge which you fill with water and set the bottom edge of the lid into to create a water seal. A couple of small bleed holes in the lid edge allow the excess CO2 inside to escape as needed. There are also a set of fitted stones which are placed onto the vegetables inside to keep the food below the surface of the solution while fermenting.
    These simple features keep the fermenting food from spoiling or being ruined by fungal spores from the atmosphere – a common occurrence when attempting this in a regular crock. If you put a batch of vegetables away for a few weeks and end up with a nasty mess, you’ll soon give up on the idea of home fermenting – but on the other hand I’ve never had anything but beautiful results with this crock.

  32. Hi Paul,
    Can you offer any supplemental &/or dietary additions/changes to aid (hopefully speed up) the healing of an injured knee. More specifically healing a damaged medial meniscus (fibrocartilage).

    “The medial meniscus is a fibrocartilage semicircular band that spans the knee joint medially, located between the medial condyle of the femur and the medial condyle of the tibia. It is also referred to as the internal semilunar fibrocartilage.” http://en.wikipedia.org/wiki/Medial_meniscus

    One thing i have already implemented, is to increase my D3 intake whilst my knee heals. After reading this semi-relevant study,
    Which reported “a significant decrease in 25(OH)D of ?40%” post knee surgery. And, “At 3 mo, 25(OH)D and free 25(OH)D remained significantly lower (20% and 30%, respectively”.

    The study relates to surgery of the knee, so essentially a ‘double’ attack of the body.
    Hopefully my injury will not require any surgery, but time will tell.

    Thank You

  33. Paul, I posted the comment about the crocks and then found your post on the kimchee. The method you talk about is certainly quicker – I sometimes let the fermentation go for six weeks (this type of crock eliminates the yeast formation).
    Do you have any thoughts about health or nutritive differences between the methods?

    • Hi Jack,

      When doing the fermented mixed vegetables post I looked up papers on the distribution of bacteria over time. They’re pretty good after two weeks — once the brine becomes highly acidic, only good bacteria flourish.

      It’s not necessarily bad to go longer, but the chance of mold developing increases, and the quantity of dead bacteria will rise over time, so eventually you get a bigger population of toxins like LPS.

      • Thanks – I’m going to use shorter fermentation time.

        • I missed part of the earlier posts, but has seen Pickl-it lacto-fermentation systems? Their site seems quite informative. I own several of their jars, and they are really high quality (lead-safe glass, etc) and easy to use. Best pickles I have ever had! I just set up a batch of kraut today. I believe the time she mentions is 10-12 weeks to properly cure the kraut, which increases nutrient levels (such as vitamin C) as well as reduces histamines and anti-nutrients created from the cabbage within the first couple of weeks. I cannot remember the exact details, but I believe she has the info on the website. The process is different with different vegetable substrates, of course. For some reason, those round cabbages seem to be a more particular case.

          • Thanks Tania! I like this device. It combines the features of the bigger crock with the advantages of the small batch method. Excellent idea.

        • Paul, here are a couple of articles on fermentation.


          They seem to indicate that, just as you’ve shown , ferments can be done in a fairly short time and without any particularly specialized equipment. Pressure venting vessels, such as gairtopf crocks and pickl-it jars, can be convenient and maybe increase reproducibility of results but can also be a bit pricey. Given ferments’ importance to health, I think it’s a good idea for people to follow your advice, get started and learn a bit of the science of how ferments are made and how they affect health. Then if they find doing it problematic or bothersome, or want extra convenience, the gadgets may have added value .

  34. Hi Paul, I’m not sure how much you’ve looked into CFS, but I’d love to get your perspective on the latest paper released by Dr. Sara Myhill(one of the more prominant CFS Dr/Researchers). She believes that mitochondria dysfunction is the primary mechanism for CFS. It appears that this is becoming the more widely believed model by many doctors who focus on treating CFS/FM. Any thoughts?

    If you take requests for blog subjects, I’d love to see something on mitochondria health!

  35. Am I the only one that doesn’t have a Q&A tab anymore on the site? To find this page, I have to google “perfect health diet” “Q&A”.

    Paul, are you still working on adding forums to the site?


    • Hi Jonathan,

      I’m re-arranging the site — the Q&A page is under the “Resources” tab.

      The reason for this is the forum will be up soon and I want to move Q&A to the forum, so this page will be de-emphasized.

      • Phew! I thought perhaps that there was a conspiracy at play with the goal of keeping me from asking you additional questions. Looking forward to the forums!

      • Hi Paul,
        Will you still leave this Q&A available as an archive?

        Also, is there a search feature where or some way that I can see all my comments in one search? (for reference purposes)

        • Yes, it will still be available as an archive. Comments will be searchable but I don’t know if that specific function is available in WordPress. I will look into it later.

  36. Peter Attia has linked to this very interesting paper about a 382 day fast http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/?page=1
    If you have enough stored energy you really can live on it for a year, it seems.

  37. Hi Paul,

    Is sodium docusate safe for constipation?

    Also why are you not recommending taking R-ALA?


    • Hi Steven,

      I don’t offer opinions about medical therapies / drugs, because doctors have that expertise and it’s not easy for me to replicate their training and clinical experience. With so many more qualified experts in the world, I’d rather not be offering opinions. You can get Wikipedia’s view of it here: http://en.wikipedia.org/wiki/Dioctyl_sodium_sulfosuccinate.

      As far as ALA is concerned, it shouldn’t be necessary for most people and it’s not clear that antioxidants are beneficial, all things considered. I have an open mind about it, but I don’t consider there to be solid evidence behind it.

      • My opinion on ALA – if you’re supplementing B complex it can be good to include a little ALA as it’s also a krebs cycle co-enzyme and really belongs in the Bs; about 5mg is enough. Otherwise good for hepatitis and toxic oxidative states, but not necessarily better than NAC.

  38. Hi, Paul. Do you mind explaining why you recommend the use of iodine even in Hashimoto’s Thyroiditis? Some renowned docs state that “it is like pouring gasoline on a fire”. I’m eager to hear your rationale as to why you still recommend it.

    I was finally diagnosed with hypothyroidism after having symptoms for YEARS – looking back, I can’t believe how textbook my case was and how much I’ve suffered unnecessarily. I’ve started Armour because my issue appears to be more conversion related, but I’m waiting to start back on the iodine until I know whether or not it is an autoimmune issue. I’d love to hear your take on it.

    Also, woohoo! A forum!

    • Hi Jen,

      Well, first, iodine deficiency will contribute to hypothyroidism and it’s best to avoid that.

      Iodine deficiency can also make a thyroiditis more severe.

      Iodine has immune functions and many cases of Hashi’s are probably infectious in origin.

      We ran a series of posts on iodine in Hashi’s — look through the hypothyroidism category. Basically, taking iodine tends to reduce antibody titers and doesn’t flare the disease if it is done properly with appropriate cofactors.

  39. Hi Paul,
    I have a few questions about starch. Does potato contain more nutrients than White Rice? If yes, would you recommend potato for starch moreso than Rice?

    Also, is 2 russet potato plus 4 cups of White Rice excess starch?

    And…what are the harmful effects of excess carbs?


    • Hi Monnyica,

      Yes, potato is more nutritious than white rice.

      I do think potato is better than rice, but rice is often more convenient, so both have a place.

      2 russet potatoes plus 4 cups of cooked white rice is more than we would recommend — maybe twice as much — that would probably be a 50% carb diet, but you’d have to weigh the food to tell.

      Harmful effects — that is too complex a question to answer in comments!

  40. Hi Paul,

    A couple of questions concerning produce from China:

    My family love frozen raspberries and blueberries as a snack. Unfortunately where I live these tend to be products from China. Should we reduce our intake of these berries or is it likely that the benefits outweigh any downsides. We’re very much hoping that we can keep enjoying them.

    Similarly the only available rice vinegar is also from China. Should I avoid it based on this? If I have to go with another vinegar, is standard white vinegar (“brewed from fermented spirit”) or white wine vinegar a better choice?

    Many thanks for your ongoing brilliant work.


    • Hi Adam,

      You’re probably aware that there are frequent reports of problems with some Chinese foods, including exported foods. Here is an old story from Taiwan (http://www.taipeitimes.com/News/taiwan/archives/2004/12/07/2003214064):

      Lai said lax regulations in China made the quality of Chinese agricultural products inferior to other countries. He also added that two years ago, Japan detected residues of toxic dichlorvos at levels 28 times higher than what is acceptable on produce imported from China.

      China’s food safety regulations are far lower than those of its neighbors. Farmers there are permitted to use preservatives such as formaldehyde.

      In addition, Singapore and Hong Kong also reported exceedingly high levels of heavy metals and pesticides in mushrooms imported from China, Lai said.

      Lai also said Chinese farmers often add sulfur dioxide or formaldehyde to keep mushrooms pleasing to the eye, but these chemicals pose a threat to human health.

      Here are some other links, some more recent, and one discussing vinegar (not rice vinegar):

      mushrooms: http://english.chosun.com/site/data/html_dir/2011/07/06/2011070600820.html

      cooking oil: http://www.upi.com/Top_News/World-News/2011/09/14/China-cracks-down-on-gutter-oil/UPI-18941316059062/

      milk powder: http://www.bbc.co.uk/news/world-asia-china-18456795

      meat: http://www.theepochtimes.com/n2/china-news/china-lean-meat-powder-scandal-implicates-professor-59802.html

      vinegar: http://shanghaiist.com/2011/08/03/you_think_thats_vinegar_youre_buyin.php

      Of course most Chinese-produced food is probably safe, but we don’t know how to evaluate its safety. So you have to use your judgment.

      • Hi Adam and Paul,

        I’m actually in China at the moment. Since I have been here I have been shopping and buying food from the local markets.

        On the surface, I’m actually surprised at the level of cleanliness at the local markets here. I buy meats, seafood, and vegetables to cook and eat everyday. However, like anywhere, it’s a little difficult to know exactly what you’re eating. What I mean is, how was the meat/seafood/vegetables raised or grown? Pesticides? Type of feed? Etc.. It is virtually unknown.

        Here is another story from China about pigs being fed kitchen waste from houses and restaurants… surprising to me is that the practice is common in Japan and South Korea.


        I am just hoping that eating as cleanly as possible over here will enable my body to get rid of any added toxins it acquires.

        If I was back in Australia, or in America like yourself, I would recommend avoiding products from China. Try and find the best locally grown, or other international products, that you can trust and be sure in.

        Like Paul said, it’s hard to know the quality of products coming out of China.

        The level of mindlessness over here when it comes to Food Safety is mind-boggling! But when a country has to feed so many people they have to do whatever they can do to ensure there is enough supply of food.

        Personally, I think what is happening over here is a great message for reducing the worlds population overall. But that’s another topic for another day ;o)

        Best in health to you both,


  41. Dear Paul,

    could you give some clarification on the effects of starches/sugars/fiber on the gut flora? I’m currently thinking about leaving out the potatoes and rice and supplementing with dextrose powder instead as my glucose source. The problem is that I don’t understand certain things that I need to understand in order to make that decision.

    For instance, the GAPS-diet forbids starch but allows fiber. I don’t get that. Pathogens might be able to feed on starch, but won’t they also feed on fiber?

    You generally recommend starch for everybody (and I get why, as you see glucose as a beneficial nutrient). So, do you think that, let’s say someone who has sibo could recover from sibo although he/she is eating starch? (for instance by recovering from hypothyroidism or by eating lots of probiotics or by generally supplementing the nutrients that they are deficient in). Or let’s ask the question in another way: Do you believe in the theory that consuming probiotics/starving pathogens are only secondary because the gut flora will, as long as the rest of the body works well, regulate itself?

    Or let’s ask it this way: do you think introducing friendly bacteria is more important than starving the bad guys?

    I’m hypothyroid and i believe that I need to adress this issue first and foremost in order to heal my gut (I’m currently on the iodine protocol + co-factors + circadian rhythm therapy in order to achieve this). However, I would like to support the gut as well as I can while doing this (after all, gut and thyroid work synergistically as you/chris kresser like to point out).

    So do you think replacing starch with dextrose powder could help or is it unnecessary?

    Also, if I would follow the strategy to leave out starch in order to starve pathogens, do you think the small amounts of maltodextrin in supplements would do harm?

    Thank you,


  42. Bumped up carbs to 2 cups of white rice a day, totaling about 90 carbs a day (short grain jasmine rice – cooked in rice cooker of course).

    Ok to have a cup with 4 egg yolks on it for breakfast and the other cup with fish for dinner? or should carbs be more spaced out?

    lunch is usually steak salad, and plenty of cheeses throughout the day to snack on…..of course some dark chocolate too!

    • Yes, that’s an excellent schedule. You might want to add vinegar and vegetables to the rice to help reduce the glycemic index.

      • Funny you should say that….

        when my wife prepares rice with fish, she makes a sauce on the side composed of white vineger, chopped onions, and chopped tomatoes…..

        she will say, of course add vineger….and she didn’t even read your book…..yet

        when i got her on coconut oil for frying etc, she said, that is the oil she grew up on…..

        when i said sardines and herring are the best fish due to O3 and low Hg levels, again she said, sardines were her staple fish (and milk fish, tilapia, etc?)

        also, when i came home with bone marrow for bone broth soup she looked at me and asked why i didn’t have this years ago as she cooked it regularly

        list goes on and on……

        any guess on where she grew up…..

        oh and before i forget, i made the chopped beef liver as per your recipe, and she said it was fantastic…..however, i couldn’t down it.

        • Hi Evan,

          Great story! There is so much wisdom in traditional diets that most of us have lost, and one of the exciting things about PHD is that we’re reaching conclusions from the science and then finding that traditional diets recommended the same things.

          I don’t know where she grew up, coconut oil suggests southern Asia but sardines and herring suggests Scandinavia. Where was it?

          Sorry you didn’t like the liver!

          • She didn’t have herring, but did have sardines, coconut oil, and many many parts of the animals etc.

            As for safe starches, a local food is something called ‘ube’, it is a purple yam.


            Would PHD consider this a safe starch?

            Philipines. And like you said, it seems like the traditional diets reached the same conclusions as science….and why not, they essentially had generations of human test subjects.

            Kosher diets as well have similar insights too, no?

          • Hi Evan,

            I would consider those safe starches, although they do have some potentially problematic compounds like oxalates.

      • Hi Paul! I am assuming that lemon or lime juice will also help with the glycemix index of safe starches? I usually use lemon or lime, but occasionally I do use raw ACV for acid for salads, etc. since my last blood test showed my CO2 blood showed I am dealing with acidic blood.

        p.s. I’m making your DELICIOUS Caesar salad for dinner tonight…I’m kind of obsessed! 😉

  43. Hi Paul,

    The naturopath has suggested me to eat clementine and tangerine for bile,and to limit acid found in vinegar or lemon.. . What’s your idea about this suggested fruits considering the limited amount of fructose recommended in PHD ?
    Thanks a lot ! Can’t Wait for the NEW book ! I’ll spread the “good” teach in french as soon as possible ! 😉


    • Hi Maya,

      Citrus fruits are good for clearing/avoiding gallstones but they’re not bile precursors. Vitamin C and taurine would help for that.

      You can do lemon juice or lime juice instead to reduce the sugar.

  44. Thanks a lot for your quick answer,Paul ! In fact, the body doesn’t like tangerine in my case…since I ‘ve beginning PHD, it’s like my “mouth” was very sugar sensitive like.
    I’ve forgot to ask something else 🙄 ! Even if I follow PHD , I was diagnosed dolichosigmoid (no bowel movement, spasms, and pain with stress,bloating…) What would you better recommend to avoid or prefer as a carb source for this particular situation and to maintain a weight loss goal? (rice? potatoes ? bananas ? all 🙂 ? )
    Again, thanks so much !

  45. Hi paul

    what would you suggest for somebody with both candida and sibo concurrently?


  46. Does sprouting grains (not wheat) and seeds decrease or increase the plant toxins? There is a meal replacement on the market that largely uses organic sprouted grains and seeds in the formula. Thanks for the time you spend on answering our questions!

  47. Hi Doctor Jaminet,

    Do you recommend medication for disorders such as Attention Deficit Disorder or Depression or do you believe these are treatable through diet/supplementation?

    I have been taking an antidepressant for upwards of 3 months now and have noticed improvement in my mood, but this was also right around the time I switched to your PHD from a low carb paleo type diet. I’m now considering switching to a medication for attention deficit disorder which my doctor believes that I have.

    Lastly, I’ve also seen you mention that depression is often caused by a certain infection. What infection was this?

    Many Thanks,


    • Hi Jeff,

      Everything improves with better diet, nutrition, and lifestyle, including ADD and depression.

      So I recommend getting on a good diet and lifestyle, letting symptoms clarify themselves — typically some resolve and the remaining ones may change their character — and then consulting a doctor to revise diagnosis if necessary and decide on appropriate treatment steps.

      Since all medical treatments are experiments which may help or hurt you, it’s good to try them as isolated controlled experiments. That way you would have a better idea how much of the improvement was due to diet and how much due to medication.

      Almost any infection can cause depression, because it is the immune response to infection which generates the depressive symptoms. The body wants you to lie down, rest, avoid people so you don’t spread the infection, maybe eat less than normal (sometimes more than normal), all of which help fight the infection. Depression is its vehicle for achieving those behavior changes.

      So we can’t diagnose the infectious agent from depression, but it does mean it may be worthwhile to experiment with antimicrobial drugs or nutrients with antimicrobial effect like NAC.

    MacKenzie, Congress has returned to Washington, D.C. to work on a number of pressing issues, including an omnibus 2013 Appropriations Bill. Unfortunately, a dangerous biotech policy rider is still on the table. The provision (section 733) is intended to force the U.S. Department of Agriculture (USDA) to deregulate and grant temporary permits to genetically engineered (GE) crops even if a federal court rules that the USDA hasn’t adequately considered the environmental or economic risks.


    There is only a short period of time for Congress to dump the Monsanto Rider from a lame duck Appropriations Bill — email your Representative and both Senators today!
    Though wrapped in a “farmer-friendly” package, this biotech rider will allow GE crops to continue to be planted even when a court of law has found they were approved illegally.
    This biotech rider would negate any meaningful judicial review of the USDA’s decisions on GE crops. In other words, if a GE crop approval was shown to violate the law and require further analysis of its harmful impacts (as several courts have concluded in recent years) this provision would override any court-mandated caution and allow continued planting and commercialization while further review takes place.
    Furthermore, under this provision, if industry requests permit approval of a GE crop the USDA will be forced to approve such permits. Essentially, this creates a loophole that allows the industry to take charge over regulators.
    In response, Representative Peter DeFazio (OR) has authored a “Dear Colleague” letter opposing the biotech rider and urging his colleagues in the House to join him.
    Please tell your Representative to support Representative DeFazio’s Dear Colleague letter opposing the biotech rider and ask your Senators to urge Senate Appropriations Chairman Inouye (HI) to oppose the rider!

    More info here http://www.organicconsumers.org/articles/article_25791.cfm

  49. http://jcem.endojournals.org/content/84/3/873.full.pdf


    interesting studies of hypothalamic amenorrhea find high fibre intake, more aerobic exercise (but less exercise overall), low fat intake are factors.
    “Hidden nutritional and metabolic insults”

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