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. Funkadelic Flash

    Hey Paul,

    I was wondering if you could help me interpret some numbers that I recently got back from a company wellness check.

    First, a little background:

    *23 year old male
    *190 lbs
    *About 10-12% BF

    *Eating Primal/Paleo/PHD for about 1.75 years
    *Eat similar to leangains with higher carb (200-300g) on heavy lifting days and lower carb (50-150g)other days (all in the form of sweet potatoes, white potatoes, winter squash, and sprouted/soaked brown rice)
    *About 150-200g protein per day all from grassfed ground beef, heart, kidney, and liver; omega-3 eggs; and wild-caught sardines.
    *Fat sources include coconut oil, grassfed tallow, and a very minuscule amount of olive oil. I don’t add too much extra fat to my meals unless I’m frying eggs.
    *IF for 16 hours every day with 2-3 meals in my feeding window
    *Eat 4-8oz beef or lamb liver/week
    *Include at least 3 egg yolks on days I don’t eat liver (for the choline)
    *Eat a generous serving of homemade fermented vegetables with most meals
    *A few cups of bone broth every day

    *Lift heavy weights 2-3x/week
    *Sprint once every 1-2 weeks
    *Stay moderately active every day
    *Eat similar to leangains with higher carb (200-300g) on heavy lifting days and lower carb (50-150g)other days

    *400-600mg magnesium glycinate on most days
    *5mg mk2 a few times/week
    *Plenty of Colorado sun for vitamin D
    *6-10mg iodine/day

    Second, the lab results:

    (I know lab ranges are not of great use, but I’ve included whether the results were low, normal, or high in parenthesis)

    *Blood Pressure – 110/58 (normal/low)
    *HDL – 64 mg/dL (normal)
    *LDL – 111 mg/dL (normal)
    *TC – 186 mg/dL (normal)
    *Trigs – 53 mg/dL (normal)
    *Fasting BG, 13.5 hrs fasted – 90 mg/dL (normal, though I know this is higher than it should be. It could be due to the fact that I had just rode my bicycle 13+ miles to work.)
    *Gamma Glutamyltransferase – 11 U/L (normal)
    *Glycated Serum Protein – 218 umol/L (normal)
    *Blood Urea Nitrogen – 25mg/DL (slightly high)
    *Creatinine – 1.2 mg/dL (normal)
    *Total Bilirubin – .5 mg/dL (normal)
    *AST (SGOT) – 35 U/L (normal)
    *ALT (SGPT) – 52 U/L (high)
    *Alkaline Phosphatase – 58 U/L (normal)
    *Total Protein – 6.9 g/DL (normal)
    *Albumin – 4.7 g/DL (normal)
    *Globulin – 2.2 g/DL (normal)

    So, as you can see, the only two things that are outside of normal lab ranges are the blood urea nitrogen (which was TECHNICALLY within the lab ranges, but still elevated) and ALT (SGPT).

    I’m assuming that the nitrogen is due to too much protein, so I could try reducing protein and replacing some of those calories with more fat.

    As for the ALT, I don’t quite know. I’ve done some googling around, but haven’t had much luck other than it has to do with liver function.

    Any advice would be much appreciated! Your hard work and dedication to helping your readers find “perfect health” has truly been an inspiration to me.


  2. Well the thing is that Paul’s Ketogenic diet is different from others in that the others completely eliminate starch/carbs. But he thinks it best for over all health to have 200 calories of safe starch. So you are going to have to learn to count just that little bit if you want to try Paul’s version. Not hard to do really. Maybe get one of those little scales that measure both in grams and ounces.

    Here is what he said in 2010 in that thread I linked to earlier:

    “The safest and healthiest way to eat a ketogenic diet is by:

    * Restricting carbohydrate consumption to 200 calories per day from “safe starches” like rice, taro, and sweet potatoes. 70 grams of cooked white rice, 150 grams of taro, and 300 grams of sweet potato are an appropriate daily ration.
    * Eating massive amounts of coconut oil. The short-chain fats in coconut oil are the most “ketogenic” of foods, i.e. the most readily turned into ketone bodies. 6 to 8 fluid ounces (12 to 14 tablespoons) per day of coconut oil is an appropriate daily ration.”

    Me again: For the rest just follow the basic PHD diet with no fruits, sweets etc. i don’t think it will matter that much if you don’t count, measure anything else. Just have a “Normal” portion of protein and as much veg as you want.

    The coconut oil is crucial as it is what puts you into ketosis while still consuming enough safe carbs to protect other aspects of your health. But you may not need the full amount. Increase slowly. Experiment.

    Hope that helps and that Paul will correct me if I got anything wrong.

  3. Hey Deb– regarding your son’s allergy symptoms increasing at night time. I’m willing to bet that because of circadian rhythms, cortisol naturally is lowest at night– and because cortisol acts as an anti-inflammatory agent and reduces histamine, that is why his itching increases as the day progresses. You might want to look into that angle further. Are his adrenals weak by chance? I bet they are!

  4. Forgive my ignorance, but I’m a bit confused by the 200 – 400 calorie / 0.5 lb – 1 lb protein target you recommend in your diet.

    I had assumed that when you say “protein should be a modest fraction of daily calories” you used the word “protein” to mean meat, fish and eggs. However, according to the USDA, 0.5 lb – 1 lb of cooked beef usually amounts to 450 – 1,000 calories. This would seem to contradict the expectation, implied in your diet, that consuming 0.5 lb – 1 lb of meat such as beef should result in 200 – 400 calories from food groups high in protein.

    Perhaps by “protein” you mean here something other than what I’ve assumed?

    I would be extremely grateful if you could explain what I’m missing.

  5. Thanks, Ellen; I appreciate your input. That sounds nice and simple. I think I was trying to overcomplicate things.

  6. Dear Paul,

    I bought your book recently and have been reading this blog too. I’m not sure whether I’m able to fully do your diet but I really like the friendly tone, the lack of ego and generosity in sharing your knowledge. I’ve been quite dismayed at the amount of hysteria and vitriol that seems to pervade the discussions of different diets and their proponents, so it’s very refreshing that you’ve managed to inspire a courteous and genuinely inquisitive discourse on the subject.

    I have had ankylosing spondylitis for about 30 years, the first few with lots of pain, less so since then. Also a few bouts of associated iritis. I noted with interest that you know about the research on klebsiella, starch and AS by Alan Ebringer.

    Over the last 7 months, I have been trying various low-carb diets – paleo, SCD, GAPS, urban caveman, with mixed results and wonder whether you’ve got any advice.

    I obviously have an ongoing need to keep inflammation to a minimum but, for much of the time, this is nowhere near as much of an issue as it was in my twenties, when I was diagnosed. At one point, about 18 years ago, I was eating a very high carb vegan diet for about 18 months and experienced very little inflammation, although I did have many other symptoms.

    Cureently the main issues are insomnia, bloating, constipation, fatigue, hypoglycaemia, low blood pressure, brain fog,fungal infection on feet and kneecaps(!), fibromyalgia. I have also had tests showing high liver enzymes and raised T4. This was about 5 weeks after starting low-carb and I’ve no idea whether these readings were on the way up or down. I feel a lot better now than I did at the time the tests were done so I’m not particularly concerned – they’ll be repeated in a few weeks time.

    On the low-carb diets I have less bloating (but still some), less brain fog and much less fibromyalgia, none at all if I take magnesium. I feel that it is definitely better for me to not eat grains/pulses (I used to eat them for 1 meal a day).

    However, my energy is very variable, sometimes very low, I sometimes get palpitations, dizziness, weakness and I have lost far too much weight and am seriously thin. I eat lots of good fats and am living proof that fat doesn’t necessarily make people fat.

    I eat squashes, beetroots and carrots. Starches such as sweet potatoes/potatoes etc exacerbate the bloating and fungal infection on the skin, although I usually feel more satisfied after eating them and really wish that I could get away with it.

    I don’t seem to tolerate most dairy, apart from sheep’s yoghurt.

    I’m desperate to put on some weight so would appreciate any tips.

    Also, I’ve read with some concern your observations on the dangers of zero-carb diets. Do you consider the SCD/GAPS diets to be dangerously low in carbs? What about people in situations such as mine who need a therapeutic diet and may have no choice, for now at least?

    I hope that this is the right place to be asking this kind of question.

    Many thanks

  7. Hi Everyone,

    I’m sorry for the delay in responding to questions. I have been (and continue to be) very busy, but will catch up as soon as I can.

    I left off with questions of September 29, and will provide links to the questions until I’m caught up.

    Hi Tom,

    Re (1), I do believe that iodine improves immune function. I don’t think it’s a cure-all, but it should make things function better. I recommend going for every advantage you can.

    I like anything from 3 mg/day to 12 mg/day as a maintenance dose, I do 12 mg/day. I think if you get there gradually and take the important co-nutrients, especially selenium, there shouldn’t be a problem.

    Doses over 12 mg/day I would consider more pharmaceutical in nature. Could be helpful, high dose iodine once upon a time was a favored therapy for infectious diseases of unknown cause.

    Upper limits – Not really. People have taken 700 mg/day for extended periods, but I would stay around 50 mg/day or at most 100 mg/day if you go the pharmaceutical route.

    Re the bloating with starch, have you tried rice syrup? It’s basically pre-digested starch, and a good way to get more glucose while you’re sorting out the gut problems.

    The real solution is to re-shape your gut flora. Probiotics, fermented vegetables, fermented dairy, good immune function, and persistence.

  8. Chris Antenucci

    Hi Paul, I have a few questions about your dietary advice for people with IBS and small intestine bacterial overgrowth. You said that people with these disorders shouldn’t have fructose except in fruits because they often have fructose malabsorption and it also feeds the bad bacteria. Since this is the case, wouldn’t it be better to remove all fructose from the diet, including from fruits? You also claim that if a person has small intestine damage, they shouldn’t have fatty foods since the enzymes that digest fats and proteins also may digest our own cells, but you didn’t provide any evidence of this, so I’d like to see some evidence supporting that claim. You recommend eating safe starches almost exclusively for people who have small intestine damage, but wouldn’t this provide food for the pathogenic bacteria? In the very next sentence in that blog post you quote a paleo blogger who says that people with IBS get better rapidly on the paleo diet, which is high in fatty foods, so you seem to be giving conflicting advice there. I’d appreciate if you could clear this up for me. Thanks.

  9. Hi Kristina,

    I wouldn’t be surprised if Lyme and Babesia can cause POTS. My best wishes for recovery. Are you taking antimicrobials?

    Hi Scott,

    I’m sorry I’m so late responding. How are things going now?

    Hi Michelle,

    Yes, I’m speaking at Wise Traditions 2011 on Saturday morning.

    We never did a Bowel Disease Part V. I guess we’ll have to pick that up again sometime!

    Hi Bill,

    Yes, microwave away, they should have all their antioxidants!

  10. Thank you Paul and Ellen for your comments. I really appreciate it. I’ve scheduled an appointment for a complete blood work up.

    Many Thanks,


  11. Paul – not to add to your burden but had an interesting experience yesterday and wanted to share (also for sweet feather). Yesterday I had another histamine episode (after forgetting about histamine in egg whites, which I had the night before). Its hard to describe these episodes, but usually consist of headache, feeling really sick and no energy, sometimes nausea. Normally, this would have kept me unproductive for at least 1 day, maybe 2 days – like sick in bed sort of thing. I decided to take Vit C + quercetin, and amazingly, it diminished most of the symptoms! The headache was gone in a half hour. I’d say 90% of the symptoms cleared up, and stayed cleared up, but had to keep taking it all day. I tried Vit C on its own, but it didn’t work as well as with the quercetin (which I have tried on its own, also didn’t work as well). I am so encouraged! Sweet Feather have you considered Vit C supplementation and quercetin instead of the antihistamines?

  12. I would like to ask your permission to use your apple graphic, which is as perfect an illustration of eating principles as I have seen, in an attributed form which refers people back to this website, in a patient leaflet intended only for distribution in my own clinic. I cannot find a direct email link, but if you would like to view the draft leaflet while considering this request, a mail to me at the above address will elicit a copy by return email. Thank you.

  13. Hi, I am anxiously awaiting your book to come in the mail and excited to try your plan. I have a question I was wondering if you had any info on. I’m a 33-year-old female, hypothyroid, overweight (for the last 10 years I’ve been yo-yoing between low carb <20 g/day getting down to 170 pounds to the other extreme of take out every day for a few months -namely taco bell, chipotle, and pizza and getting back to 210). I'm currently not on thyroid meds because I just hated taking meds every day for many years when they didn't help any of my symptoms (tried both synthroid and dessicated pig from a compounding pharmacy). My big thing is, and to which none of the 3 doctors even cared a little bit, is I have ZERO sex drive. I'd say even less than zero, I usually wrinkle my nose when my husband says he's interested, and I know this isn't normal. It's been like this for close to 5 years. One doctor just said "that's a bummer" and didn't offer any help. Is there any hope to get my sex drive back, as well as my hair loss (can see my scalp every easy on the WHOLE top of my head) by diet and supplements alone? I've tried different biotin supplements. I'm currently on 5000 iu of vit d, vit C, borage oil (for supposed brown fat activation), zinc, potassium, magnesium. now that I think about it, I think my bad hairloss started around the same time as my zero sex drive. I'm not a vegetarian, but hate meat and eggs actually, and was thinking maybe it was the lack of protein leading to my hair loss so I tried adding in protein drinks (which I have a hard time drinking my meals). I then started adding in protein powder to yogurt twice a day, which I love, but I started having extreme mucus in the back of the throat all day, constantly having to clear my throat and/or cough it up, so I stopped eating yogurt and it's pretty much went away (the mucus). I'd love any info on supplements or anything that address my zero sex drive, hair loss, and hypothyroidism. Could I possibly need hormone replacement therapy at 33? I still have regular monthlies and feel great, other than the no sex drive and lack of hair and extra weight. Thanks so much for your time!!

  14. Hey Paul– have you ever used Shou Wu Chih? If so, what’s your opinion?

    Hi Ellen,

    I haven’t used it personally but some of the ingredients are in my anti-fungal medicine mix, and I’ve seen other people use it to good effect. I think it’s fine in moderation, and it can help hair regain its color.

    Best, Paul

  15. I would love to hear your thoughts on this blog post about how phytates might actually protect against cancer:
    This adds to my confusion about what I should actually eat (brown rice? white rice? soaked nuts? unprepared nuts? no nuts at all? Maybe only the dust on my cupboard can be eaten safely :-()…The PHD approach seems plausible but as I try to keep an open mind contradicting reaserch still makes me curious…

    Hi Dinah, That thought has been around for years. IP6 has a definite anti-cancer effect. However, results are more impressive in test tubes than in vivo. Here is a representative clinical trial: http://www.ncbi.nlm.nih.gov/pubmed/20152024. Also, things that are toxic to cancer cells are usually toxic also to normal cells. So I wouldn’t consider it unless you actually have cancer. Best, Paul

  16. Hi Paul,

    Is it best to spread out my supplemental vitamin C over the day? I take 500mg most days (in addition to the 90mg in my multivitamin), so would it be best to take 250mg in the morning and 250mg later in the day? I really have no outstanding health problems, so this is purely from a prophylactic standpoint. Thanks!

    Hi Nick, At that dose I don’t think it matters much, I would take a single dose for convenience.

  17. Paul, I have a question. I am starting a ketogenic diet for my migraines. You have written that 70 grams of cooked rice provides 200 calories of safe starch. But when I put my data into Chron-O-Meter, it assigns a value of 91 calories to 70 grams of cooked starch. If Chron-O-Meter is correct, that means I could be having 154 grams of cooked rice per day.

    Could you please clarify?

    Thanks for any help!

    Hi honeybee, that was a mistake, it was referring to uncooked rice and said cooked. Your Cron-o-meter is correct, cooked rice has about 1.3 calories per gram.

  18. Hi Paul,

    Thanks to you and your lovely wife for all that you do. I love your book and website!
    I have a question about carbohydrate sources. I suffer from GORD and have a family history of osophageal cancer. I’m also hypothyroid with a low T3 level but no thyroid antibodies. A low-carb diet has proved very effective at controlling my GORD symptoms, but it does nothing for my thyroid symptoms.
    I find with the safe starch sources that you recommend that I will often get an exacerbation of my reflux. I am currently increasing my carbs by eating fermented dairy, fruits and a little honey, but I worry about the fructose content of the fruit and honey particularly.
    Can I ask what you recommend, if anything, for someone like myself, who wants to keep carbs in the 400-600 calorie range that you suggest, but who is unable to tolerate the di and poly-saccharide carb sources?
    Again, many thanks for all that you do.

    Hi Emma,

    There are two issues to address — one is finding the most tolerable source of carbs, the other is fixing the acid reflux / gut dysbiosis.

    It sounds like you tolerate sugars OK, so that suggests trying rice syrup. It lacks fructose but is digestible like sugars.

    For the acid reflux, reshaping the gut flora with polysaccharide digesting enzymes and fermented vegetables, and nutrition for gut barrier integrity such as collagen, bone broth, vitamin C, sulfur, rice syrup, minerals generally, and vitamins D/A/K2.

    Please let me know how things go. Best, Paul

  19. Paul,
    Not to be deprecating (at all), but a lot of the citations on many of these blogposts seem to only have the abstract; Just wondering if that’s what most of these recommendations are based on, or have you been able to access most of the actual texts (and subsequently relaying your assay of these full texts in your book/blogpost). I just ask because I see tons of citations and I was hoping that they bring solidarity to this diet/’set of nutritional principles’ instead of relying on the same, easily discreditable science that made people fear fat and such in the first place.


    Hi Josh – I do have full text access via my wife’s Harvard position, and you can take it for granted that I read papers I cite sufficiently thoroughly to justify the cite. – Paul

  20. Hi Paul, listening to the last podcast you mentioned hypoglycemic like symptoms you experienced likely caused by chlamydia pneumoniae. That led me over to cpnhelp.org to do some research. The cognitive and fatigue problems, and the genesis match perfectly with the onset of my CFS a few years ago. I’m starting the CAP. Do you have any advice about the length of the protocol, or which protocol to use from your experience?

    Hi David, I used the Wheldon protocol myself. I don’t have advice about antibiotics, I leave that to doctors, and to sites like cpnhelp where people can trade experiences. The only thing I would say is that since you don’t know your pathogen for sure, you may need to experiment to see what works. Different antibiotics work on different germs, or even different strains of the same species. I would suggest starting with a single antibiotic to see if it has an effect, I think doxy is a good one to start with. The protocols usually advise adding antibiotics and building dose slowly. If you have a severe case, you will find detox aids helpful too. Best of luck and let me know how it goes. Paul

  21. Thank you Paul. I forgot to ask about probiotics while on CAP. VSL 3, kombucha, or other supplement? My doctor didn’t offer anything.

    I don’t recommend specific brands, but quantity is more important than anything else when you’re on antibiotics. You need to keep your immune system vigilant. I strongly recommend yogurt and homemade fermented vegetables. This will have larger quantities than most probiotics, and greater species diversity. But do take probiotics as well, focusing on quantity of organisms. You can take multiple pills per day so price per organism is the best metric. I would avoid yeast fermented foods while on antibiotics, personally. Best, Paul

  22. Paul,

    Have you heard of iodine causing frozen gut? A friend wrote me this:

    “My biggest problem with iodine is that it seems to cause a imbalance in my neurotransmitters in the gut and I get frozen gut symptoms. I’ve never been able to get iodine even close to 50mgs which about where you need to go to cause the bromide to discharge.

    Apparently, iodine will cut loose heavy metals which might be why some of us have neurotransmitter shutdowns in our gut. Most people find their gut problems improve but there’s a small subset of us that get unreal constipation and no one has ever been able to give me a suitable explanation. I quit trying to increase my dose of I above 6mgs because of this although now that I’m not working I’m moving my way up again very very slowly. Am also using an ionic form that absorbs in faster than iodoral and that seems to be less of a problem. (am using Eidon mineral’s iodine plus a small amount of iodoral)”

    Hi Ellen,

    That’s an interesting symptom. I haven’t seen it before. It would seem to indicate the presence of biofilms in the gut and the iodine kills or releases biofilm inhabitants causing breakdown of the biofilm and release of metals.

    I would go slow, keep iodine at a level that produces minimal symptoms, and add in polysaccharide digesting enzymes (to help break down the biofilms) and detox aids (to help clear LPS/fungal cell wall components/die-off toxins and metals). I would start with a mix of charcoal, chlorella, and bentonite clay, a little of each each day. Some recommend EDTA for chelation but I would be very cautious about that.

    Low levels of iodine will drive out bromine, so I don’t think there’s anything special about the 50 mg level of iodine. I would just continue on, go slowly, and see if I can gradually eliminate the frozen gut and continue raising the iodine.

  23. Another constipation question:

    Can you think of why taking oreganol and oregamax would cure constipation?

    My guess is that it has something to do with my fungal issues. But the thing is that I only had this problem since taking a lot of charcoal and I have had the fungus in my system for eons. I took the charcoal for a month. But even 7 weeks after stopping I still was constipated.

    Stopping iodine for a while didn’t make a difference either.

    But, quite by accident, I found that the oregano products did the trick.

    Hi Ellen, Very interesting! I’m not aware of a reason why oregano would cure constipation, but it is a good antimicrobial and might have improved your gut flora. All of the traditional herbs tend to help gut flora one way or another, I think that’s why they became traditional. Thanks for sharing this! Best, Paul

  24. I have not been receiving Nofications of recent comments via my e-mail and would like to have it set up again. Thank you very much

  25. Hi isa,

    You had set your notifications for “replies only”, but unfortunately the comment system isn’t really set up to enable specific replies. I changed your setting to “all comments” which you may not want; unfortunately I’m not allowed to change it back, but you may be able to.

    I am starting to reply inline to comments, to make responses more readable, so you may need to look at comments to see my replies.

    Best, Paul

  26. Yes, I do want “all comments.” I must have misunderstood when looking through the notification options. Thank you so much. I look forward to the comments and always learn from the questions and comments of others.
    Much gratitude for everything you do.

  27. Hi Paul (or anyone with thoughts on the matter),

    I am wondering what you think about a diet such as Lyle McDonald’s UD2.0.. if you’re not familiar it is essentially a carb cycling, anabolic type diet. The dieter would severely restrict carbs and calories for 3.5 days, with intense resistance workouts and then on the end of day 3 through day 4 would amp carbs way up. Depending on the starting weight and maintenance calories carb intakes on re-feed days would sometimes exceed 1000g. The idea being that early in the week the muscle glycogen is completely depleted and then hit hard with a carb up. Of course, there is more to it, but that is my 10 second recap. I am a voracious diet/nutrition literature consumer and a self experimenter. I am considering trying the 2.0 just to see what sort of results I get, but am of course concerned about the blood glucose surge that is sure to take place during the intense re-feeds. Any thoughts on what this would mean for long term health?

    For the sake of the diet let’s assume that I eat clean/safe carbs during the re-feeds. Oh, also of note, during the re-feeds Lyle recommends fat restriction as to not exceed 15% of total calories.

    I appreciate your thoughts.


    Hi Lindsay,

    I think intermittency has some value but that’s the opposite of how I would do it. I would first of all do intense resistance exercise only twice a week at most, to give time for recovery between workouts. And I would concentrate the high-carb eating in the period immediately following a workout, to stimulate muscle growth and recovery. It’s fine to work out fasted but you should provide carbs and protein afterward.

    My recommendation is more similar to Martin Berkhan’s Leangains approach.

    I wouldn’t go as high on carb feeding days unless you’re a really intense athlete. Maybe Michael Phelps should eat 1000 g carbs in a day; I don’t think many others will benefit from such a high carb intake.

    Best, Paul

  28. Paul,

    Confused here. Reading Danny Roddy’s e-letter today and he seems to be getting the fructose influence from Ray Peat. How do you respond to the suggestion that fructose has benefits? I wouldn’t mind preventing my hair from thinning more and even regrow but adding fructose???

    “Due to my experimentation with large amounts of fructose in the form of white sugar and orange juice (losing ~20 lbs. in the process), I’m a bit hesitat to adopt Dr. Lustig’s notion that fructose is anymore of a “dose dependent poison” than broccoli, cabbage, or water.

    For the purposes of hair loss, fructose has several beneficial effects that include: increasing the metabolism (here, here), improving the utilization of glucose (here, here), less fat gain (here, here), protecting the liver (here), which all culminate to form one gigantic anti-stress-bomb.”

    Hi Jay,

    If fructose has benefits compared to glucose, they’re minimal, and only present on low-carb diets with low overall fructose intake. People who see benefits from fructose would see similar benefits from eating starches for glucose.

    Best, Paul

  29. Paul,

    Regarding the comments – awhile back I used to receive notification whenever you would edit a post. Now, I no longer do. Did you change a setting that might have changed that? Because if you did, perhaps that’s the key to allowing “revised comments” to appear in the news feeds.

    Barring that, what do you think about holding comments for moderation until you reply to them, so that they appear in the feed with your response?

  30. Hi Matt,

    For some reason I don’t see your email address listed among the subscriptions to this comment thread. Is it possible for you to leave a new comment and re-subscribe? I have no history and can’t tell what happened, and no way to add you myself.

  31. Paul,

    Have you considered doing an email subscription that notifies when new articles are posted? It would be more convenient than checking in to see, but then again maybe that gets more hits to your site and not a bad idea???

    Hi Jay – I’ll work on setting that up. Best, Paul

  32. Sheep Counteress

    Jaybird, please remember Jaminet’s Corollary (to some Murphy-esque law): “Humanity will stagnate until the internet becomes boring.” I would paste that quote to my desktop background, except I only see my background when I turn on the computer – before it gets covered by ~3 applications and a browser window containing 10+ tabs.

    Maybe it’s better that we be (a little less un-)productive and pay back in a tiny way Paul & Shou-Ching with more hits 🙂

    Hi SC – Thanks much! However, I’m happy to have people get content however they like. The reason I don’t send the whole post in RSS is that spam sites subscribe and steal the content.

  33. I’ve tried to post a question twice last week and it’s not posting. Any reason why?

    Hi Kim – It was caught in the spam filter. Sorry about that. Hopefully it will recognize you from now on.

    If it happens again, send me an email and I’ll rescue the comment.

    Best, Paul

  34. Seems to be working now, so here it goes. I have very low cholesterol and wonder if it is a problem. I have been eating a vlc paleo diet since May of this year. I have T2 diabetes. I have lowered my A1c from 11.9 to 6.0. I also had high blood pressure and have gotten off my meds about 3 weeks ago. I follow a low carb diet according to Dr. Bernstein’s diabetes solution. When eating a SAD, my cholesterol runs about 150. Since starting lc paleo these are my most recent readings.

    Total Cholesterol 114
    Triglycerides 58
    HDL 32
    LDL 70
    VLDL 12
    Chol/HDL 3.6

    Total Cholesterol 149
    Triglycerides 74
    HDL 29
    LDL 105
    VLDL 15
    Chol/HDL 5.1

    Granted my HDL has gone up a little and my LDL has gone down, but my total keeps going down. Several years ago when following a low carb Atkins diet, my cholesterol got as low as 108. I don’t know if this is a problem or not. I eat all kinds of red meat and fat and some cheese and butter. I was eating eggs but when I did an elimination challenge, eggs gave me a stomach ache. Every so often throughout the years, they have made me nauseous.


    Hi Kim,

    I think this is a problem. The reason I know of for very low cholesterol that gets worse on very low carb is infection with a protozoal parasite. Protozoa can consume lipids from blood, driving cholesterol levels low, and also ketones, meaning the infection often gets worse on ketogenic diets.

    Common protozoal infections include Toxoplasma, malaria, Babesiosis, and many others.

    There’s plentiful evidence that infections can cause Type 2 diabetes, so these issues might have a single cause.

    I would ask for a doctor knowledgeable about infectious diseases to check you out. I would also add some carbohydrates to the diet to make it less ketogenic.

    Best, Paul

  35. Thanks. I’ll check with my naturpath and see if she knows anything about infectious diseases. I was thinking about trying to add some carbs in but will need to make sure my blood glucose stays stable. I have your book coming so I can read it. Kim

  36. Hi Paul,
    My question concerns the measurement of heart and vascular health. I recently had my carotid arteries evaluated via ultrasound for plaque and narrowing and was told there is no evidence of either. A year ago, just before adopting a PHD type diet, an MRI of my heart revealed “significant” plaque on one of my coronary arteries and less significant on another. Since adopting the diet my cholesterol has gone up quite a bit, from the low 200s to the high 200s. Both HDL (mid to upper 50s) and LDL climbed (pattern A size). Triglycerides below 100. I’m in my mid 40s, lean, active, and have seen many health improvements since adopting the diet (less joint stiffness, no more chronic back pain, milder colds, fewer allergy symptoms, less gas, less bloating, need for less sleep. Should I be worried about the MRI a year ago? Or the high cholesterol? The only supplement I take is magnesium.

    Hi Alex,

    I think vascular disease often regresses quickly on our diet and supplements, and the other health improvements you’ve seen would seem to support a conclusion that the improvement seen between MRI and ultrasound was probably real.

    What does your doctor say? Can the ultrasound reliably detect the sort of coronary plaque seen in the MRI? It may be that the imaging is consistent with unchanged status as well as improved.

    I would consider adding a few more supplements: eg vitamin K2 is important for vascular health, in general the A/D/K2 complex is important and so are minerals like selenium, zinc, copper, magnesium, iodine. A multimineral supplement might not be out of place. Vitamin C can be important.

    Re cholesterol, in general anything in the 200s is OK, especially if HDL is high, but you might want to read our carbohydrates and the thyroid series, and our original high LDL on Paleo series, for nutritional and thyroid factors that can raise LDL. You may be able to refine your diet and supplementation a bit with LDL as a guide.

    Of course the MRI result was worrying, but that doesn’t mean you should worry. You’ve treated it the right way. I think the only appropriate remedy is diet, nutrition, exercise, and possibly treating any infections with antibiotics if residual infectious symptoms continue. It sounds like you’re fixing yourself up nicely, the gut issues clearing suggests your immune system is able to deal with its infections. So I wouldn’t stress about it, just keep trying to live healthily.

    Best, Paul

  37. Hi Paul,

    Coconut oil makes me very nauseous. Does this indicate that there is some kind of problem with my gut flora or digestion? I have no gastrointestinal problems otherwise. Thanks!


    Hi Nick, A number of people have reported this problem. Usually MCT oil is tolerated OK, and usually mixing the coconut oil with a lot of food makes it tolerable. I think the tricky thing about coconut oil is that half is MCTs that get directed to the liver and half are long-chain fats requiring bile and pancreatic enzymes for digestion, and some people’s digestive tracts don’t separate and direct these properly when they are mixed.

    I don’t know what causes the problem, but I have no reason to link it to gut dysbiosis at this point.

  38. Hi Paul,
    Thanks for the quick and thorough reply. I forgot to mention that I do supplement with the fermented cod liver oil that Chris Kresser recommends. I think that provides vitamins A/D and K2. But I will look into a multimineral supplement as you suggested.
    Just reread your Sept 1 post on LDL and paleo. I don’t measure my macro-nutrient intake but I don’t think my diet is particularly low-carb – I eat plenty of rice, sweet potatoes, fruit and dairy (yogurt, cheese, kefir, cream and ice cream). If my T3 levels were low, what symptoms might I experience?


    You can search on hypothyroidism and most of the symptoms would be shared. Low energy, impaired cold tolerance, low body temperature, constipation, elevated LDL, are possible symptoms.

  39. Hi Paul,
    I had a question in regards to brain infections. I’ve been attempting to eat a healthful diet (in phd terms) for a while and have been unsuccesful with every undertaking. I can go for about 3 days (my mind is always spacey and fuzzy it seems during this time) until I end up binging on tons and tons of junk food. It’s not the kind of binge that occurs because I’m craving these foods, rather my mind ends up feeling so dull it’s like I lose all concentration as well as any sense of joy or emotion. It is only after I ingest these mass amounts of food do I regain a sense of consciousness ( only way I can think to explain the feeling). I’ve tried many different macro ratios all from safe and healthy foods and unfortunately I can’t stick with them long enough to notice any beneficial effects. I’ve been struggling with these problems for a while and was just wondering if you could offer any advice. Thank you very much for any time and advice you can spare!

    Hi Sam,

    A mind that is “spacey and fuzzy” is usually due to immune activity in the body or pathogen activity in the brain; loss of joy or emotion is often due to an immune response in the brain, or else hypoglycemia. So we have to kind of sort out possible causes.

    First, you say you’ve tried a lot of macro ratios. Does the problem appear on both high-carb and low-carb diets, even ketogenic diets? Does fasting and eating coconut oil / MCT oil make the problem better or worse?

    Does eating carbs temporarily relieve symptoms?

    Is the spaceyness/fuzziness worst after meals?

    If you eat carbs separately from fats is the problem better?

    Do you have any gut issues?

    Best, Paul

  40. hey Paul, me and a friend were discussing something today and would appreciate your input. First of all, when starving, fat is used for fuel and muscle is broken down for glucose. Correct? Does this mean that on a fast, eating some carbohydrates will spare your muscle?
    Say you have a healthy person with no deficiences, and say they are only allowed 400 calories a day from ONE thing – white rice (carbs), white fish (protein) or coconut oil (fat). Which would be your choice? Which would best spare muscle protein? And whats the order of preference?


    Hi reamika,

    Roughly speaking that’s true. Muscle is more protein rich and protein becomes glucose or ketones, while fat becomes fat or ketones. So eating protein or carbohydrates will spare muscle.

    Eating ketogenic fats like coconut oil or MCT oil will also spare some glucose. Thus the two types of long fast that I recommend are “ketogenic fasts” in which you supplement with MCT oil or “protein-sparing modified fasts” in which you take protein to help spare muscle.

    If I was only allowed 400 calories a day, it would depend on the time frame. This is low enough that it would lead to starvation eventually. On very long time scales, I would go with protein, as this would postpone death the longest. But a mix of carbs and protein would probably be better. On shorter time scales, it would depend on the purpose. If it was involuntary and the purpose was just to come out without impaired health, I’d probably go with protein or a carb/protein mix again. If it was voluntary and undertaken for therapeutic purposes, eg ketosis, then I might choose either protein, carbs, or MCT oil depending on the therapeutic need.

  41. Paul,

    I weigh myself on the first of the month and saw this morning that I’d gained 3 lbs!!!!!

    The only change was reducing Vit. C from 3,000 to 1,000 mgs. No problems. I just got tired of swallowing so many capsules.

    Could that have caused the weight gain?

    By the way, did anything come to mind about my question above?

    Hi erp,

    I haven’t heard of vitamin C causing weight loss. But biology is complicated. Let me know if you can cycle weight by cycling vitamin C.

    Re your question of Oct 14 (http://perfecthealthdiet.com/?page_id=4228#comment-33844), I’m sorry I’m so slow getting caught up. I’m trying to do the questions in order so I don’t get lost. In the meantime, you can see an earlier comment thread where vitiligo was discussed: http://perfecthealthdiet.com/?p=788#comments. Here’s the Wikipedia page: http://en.wikipedia.org/wiki/Vitiligo.

    Best, Paul

  42. Hi Paul,

    When I eat/ate a high fat diet (primarily from long chain sfa’s, while limiting carbs) I would feel very dull, not much energy in my body or brain. When I tried eating a very high carb diet I would get hungry a lot and feel very uncomfortable pangs in my stomach that would usually upset my concentration on its own (though the brain fog would subside for short periods of time). I’ve noticed that eating a mix of carbs and fats (in a high calorie amount) i don’t experience the hunger and I my brain fog gets attenuated for a short period of time, but i am taking in way too many calories (aka feel heavy from all the food and gain weight). After meals is probably the only time the spaceyness/fuzziness gets better. And gut wise i haven’t noticed anything that would cause alarm, but maybe i’m missing something..

    Whenever i’ve attempted coconut oil fasts i’ve been told by others that i was way more giddy than usual…not sure if that helps any. Thank you for the speedy reply =)

    Hi Sam,

    Well, there’s definitely an issue of glycemic control. That is often due to a small intestinal or pancreatic infection. You might benefit from buying a glucose meter and testing your blood sugar after meals and fasting in order to get an idea of the nature and scope of the problem. If you can correlate how you feel with blood sugar levels, and detect major swings in blood glucose, that would localize the problem.

    I would definitely suggest eating a ketogenic diet, since that makes you feel better. Eat ~400 calories carbs but do daily intermittent fasting and eat MCT oil to make it ketogenic.

    I think it will still take some time and experimentation to diagnose what’s going on, but this seems the natural way to proceed.

    Best, Paul

  43. I’ve actually used a glucose meter before and noticed that i feel good when i’m hyperglycemic….maybe not my body so much, but my mind feels strangely comfortable =(

    Hi Sam,

    When I had a bacterial brain infection I had similar symptoms, which led me to eat a high-carb diet. If MCT oil / coconut oil also makes you feel better, that would suggest a possible brain infection. Could be worth looking into.

    Best, Paul

  44. Hi Paul,

    I was wondering just how crucial non-starchy vegetable and fruit consumption is for optimal health. If I eat very high quality animal protein and fats along with sweet potatoes for starch, are fruits and vegetables that important for chronic disease prevention? This is mainly in response to the fruit and vegetable series Peter has on his Hyperlipid blog. Thanks!


    If you’re eating starches I don’t think you need fruits. Vegetables are mainly useful for micronutrients and for modulation of gut flora. They’re not really a macronutrient source. I would be concerned with increased risk for gut dysbiosis on a zero-vegetable diet, also deficiencies of potassium, nitrates, others.

  45. Paulette Bradstreet

    Hello Paul,
    Wonderful to learn of a scholarly academic approach to healthy eating!
    Could you discuss the pros/cons of Dr. Steven Gundry’s (former cardiovascular surgeon)”Diet Evolution” method (little or no animal based protein, limited fruit,no grains) and Dr. Caldwell Esselstyn (lots of grains,fruits, beans, no eggs, no fats, no oils, no dairy,no meat, no fish, no chicken).
    Both have demonstrated reversal of cardiovascular disease. President Bill Clinton is an adherent of Dr. Esselstyn’s regime.
    Much contradictory information.
    Are there many paths to a healthy result?
    Thank you in advance for your response.

    Hi Paulette,

    Dr Gundry’s diet is similar to an Atkins Induction followed by a Robb Wolf style Paleo. I think it has its merits but is not perfect.

    Dr Esselstyn’s diet I think is a disaster. It can produce weight loss but I wouldn’t expect it to improve health or longevity.

    There are multiple paths to a healthy result, but some are straighter and some more winding.

  46. I’m sorry to bother you again,Paul , but I am just wondering how to go about following the phd diet for 3-4 months prior to antibiotic use when trying to deal with a possible brain infection if the absence of mass amounts of carbs aggrevates the cognitive hypoglycemia (neuroglycopenia) and makes it almost impossible to function– just as you were obviously drinking mass coca cola for more than taste :P. I’m just asking because every attempt I make towards eating a good diet doesn’t compare in the slightest for alleviation of cognitive symptoms–especially when I need to use my brain for college assignments all day/ everyday.

    Hi Sam,

    Well, does ketogenic dieting via MCT oil enable you to function well or not?

    If you really can’t function then it is an urgent situation and you should try to address it medically as soon as possible.

    If ketogenic dieting doesn’t help then either it is a eukaryotic pathogen or not a brain infection, so the ketogenic dieting has diagnostic value.

    Then you can try antibiotics as an experiment. I noticed an immediate effect from taking doxycycline – I went from emotionally flat to euphoric.

    In this situation diagnosis is 90% of the battle, and tools are lacking. So you have to experiment a bit.

    Best, Paul

  47. paul, thanks for what you are doing. i am having another appt. with my doctor next week and i’d like more info on what tests to ask for regarding gut and brain infection. my issues are always food related (bloat, depression, IBS fluctuating between loose and constipated bms) even eating phd/paleo. the only things that help are fasting for 8+ hours, and green tea/yerba mate/chocolate (so some combo of caffeine and brain altering alkaloids and magnesium).

    usually the second meal of the day results in near unconscious fatigue regardless of all variables. also i’ve found numerous supplements to help mitigate symptoms such as seriphos, alpha-gpc, adaptogens, ubiquinol, etc, but nothing gets me above the waterline so to speak.

    i’m on my last financial shot to cure this thing and i need some tests before i submit myself to either death or emergency room medicine that will probably leave me worse off! not trying to be dramatic but i’m looking at the black hole here. haha.

    Hi Darius,

    The best test I know of for gut problems is the Metametrix GI Effects DNA test of stool. It is expensive but it should identify your pathogens and tell you what to treat. http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/dna-stool-analysis-gi-effects

    Best, Paul

  48. paul, thanks, i took that in january, i can post the results because i cant interpret them but the highest was +4 yeast/fungus unknown. I did months of antifungals but no real improvement. I feel I’m totally missing something.

    Hi darius,

    One thing that seems to help with fungal infections is a high salt intake. It’s at least safe, easy, and cheap.

  49. Hello Paul,
    i have a 3 year old daughter who has a swollen belly, and everytime she eats she says her tummy hurts. She also has a huge eczema circle on her leg that comes and goes,and also around her mouth depending on what she eats. She started vomiting around age 15 months, which we thought was a virus, until more vomit and diarhea followed when wheta, eggs were introduced. We took her off gluten, and things improved slightly. then she got hit with bronchitis and antibitoics came. Then respiratory infection, more antibiotics. Then rectal prolapse started happening. We finally spent over 2000 to test her..comprehensive stool..blood. her albumin/globulin was always off..and her stool came back testing for dysbiosis in her gut. Candida,rhodotorula glutinis, Commensal flora was a bit of Ecoli. no parasites.They also said she had very very low secretory IgA.
    She is very skinny with no body fat whatsoever, obviously from malabsorbtion. Vitamin D was vey low as well. Her OATS urine showed us that her Citric acid cycle was very off.(KREBS). Oh and even after removing gluten her tonsils where swollen causing sleep apnea. So we took her off of everything except for veggies, fruit, and meats. (she is highly allergic to (eggs…egg whites) Her tonsils went down immediatly after about 2 weeks of no dairy, gluten,or grains or beans.

    So now..her tummy is still swollen and she seems to have lost weight..We have started to try the GAPS DIET..(without the eggs,dairy) we hope one day her gut will heal and be able to accept these things again..
    I am concerned though…she is already skinny, I fear she will loose more weight on GAPS even though the intro to the diet makes sense to heal the gut. Also the rashes have gotten worse, since i have started to remove sugars (fruit) from her diet. Is this die -off?
    And what could be causing her belly to still hurt? Whats your advice for children with these symptoms?
    Thank you so much for your insight
    One tired mommy
    Anyway..we put her

    Hi Cassiel,

    It seems clear she has a severe fungal infection with Candida and rhodotorula the main species. The gut bloating, the eczema, the diverticulitis / prolapse, are all fungal infection systems.

    GAPS is a very bad diet. It will make the infection worse, as glucose scarcity impairs immunity and ketones promote fungal growth. Removing carbs and fruit makes the diet very glucose scarce and ketogenic, that is what is causing the infection to get worse.

    You need to give her plenty of carbs — around 40-50% of calories — preferably with minimal fructose. Milk is an excellent food for her, get it raw if you can so that it will have anti-fungal proteins like lactoferrin. An all-milk diet for a while wouldn’t be a bad idea. Goat milk or sheep milk may be better than cow’s milk if available, since they’re less likely to cause an immune reaction, but cow’s milk is better than nearly any non-milk food.

    Also, make sure she gets plenty of salt and water. That will promote immunity and stomach acid production which she needs. Salt tends to make the digestive tract more sterile also which she needs.

    Then you need to focus on nourishment, especially minerals; and vitamins D/A/K2. Be sure to get her sun exposure on bare skin when you can. Our “recommended supplements” have the key ones.

    Give her epsom salt baths, for magnesium and sulfate, both very important.

    Gentle antifungals like nystatin, lufenuron, and possibly Chinese herbs are a good idea. Also, a *SMALL* amount of cholestyramine daily may be helpful for toxin removal.

    Once she is properly nourished, then you can look into probiotics and fermented vegetables and dairy like yogurt.

    It typically takes some time to recover but you should begin to see immediate progress as soon as you adopt all these steps.

    Best, Paul

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