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. Hi Paul
    RE: The last questioner on Reddit.
    See what you get when you take Scribners’ advice and mention weight loss on the cover of the new edition? Perfect health already implies perfect weight.
    Told’ja, din I. 😀

  2. Hi Paul and PHD followers. Is anyone able to help me with tips for healthy quick school lunches? Thanks so much!!!

    • Hi Amanda,

      While I don’t have kids I do have a significant other who is often like a kid 😉

      I make my S.O.’s lunch everyday.. here are a few ideas: If your kids have access to a microwave, obviously leftovers are always great. If not, how about sandwiches on a rice bread of some kind? Some of the GF breads have a small amount of oils we would rather not have, but that’s up to you whether or not you will make an exception. I do bread, organic cheese, some kind of organic lunch meat, veg, etc. Almond butter and well made jam would be a good option for kids.

      Other options; hardboiled eggs, sliced veg with dip made from homemade mayo and seasonings, slices of organic cheese (if you do dairy) individual servings of full fat yogurt with berries and nuts, salads with lots of veg, meat, egg and again with a homemade mayo based dressing. Sometimes, when I am feeling really nice I will bake off a bunch of salt crusted potatoes and then wrap those up with a container of butter and sour cream, but again that requires a microwave.

      It really depends on how much cooking and prep you have time for… if you have time to cook you can really recreate any of the convenience style lunches available in the store.

      Hope that helps!

    • Hi Amanda, You might want to do some searches on paleo kids school lunch etc. Here’s one great recipe site that has a week’s worth of ideas for kids’ lunches. http://nomnompaleo.com/post/30267255011/a-week-of-paleo-school-lunches-part-1-of-5 Other ideas: rice w/ additions, cold vegetables, fruit, lettuce wraps, etc. Hope this helps!

  3. After a while (2-3) years in the typical Paleo Diet, I came across your work and began including safe starches with positive results. PHD is the very best book there is on natural food diets! My question is on timing: is there any benefit in “pulsing” all th starch in a big night time meal? Or, is one better served to have a consistent glucose “drip” through the day maybe spread over 2 – 4 feedings? What are some of the considerations for a more intermittent carb feed? Im continually trying to optimize my approach. Thanks so much for your work and your openness to share information!
    Thanks, Patrick

  4. Hi Paul- Since going PHD with the suggested supplements, I’ve noticed that 2 (sometimes just 1) glasses of wine in the evening now disturb my sleep that night. I’m not sure if they are related. Not a big deal, as I can just as easily go to no wine. I’m certainly not giving up PHD. Just curious.

    • You probably get dehydrated having alcohol too close to bedtime.

    • There have been a bunch of studies showing that alcohol does disturb sleep. I also know from experience that if I drink, I wake up once or more at night. You’d probably be better off not drinking.

  5. Tatertot told us how to make green plantain chips and I tried shaking the sliced pantain with salt in a plastic bag before drying them, like he said, and the salt stuck. It worked really good.

    • And how were they? Pretty good, huh? I have been eating a handful (about 1/4 – 1/3 of a plantain) every morning for several weeks as my breakfast. I can’t say they are a ‘magic bullet’ but the effects of RS have been very well studied. The main effect is on colon health, but there are also shown benefits in lipid/glucose regulation, hunger, nutrient absorption, and weight loss.

      This paper http://onlinelibrary.wiley.com/doi/10.1111/j.1467-3010.2005.00481.x/full discusses just about all of the studies done and gives results (good and bad) so it’s not a one-sided industry project. A few select lines:

      – It is noteworthy that, to date, there are no reports of RS worsening insulin and glucose responses.

      – RS-rich foods release glucose slowly and therefore one would expect this to result in a lowered insulin response, greater access to and use of stored fat and, potentially, a muted generation of hunger signals.

      – It is likely that RS mediates some or all of its effects through the action of SCFA but interest is increasing regarding its prebiotic effects.

      – More recently RS has been reported to influence immune function, particularly the production of a number of pro-inflammatory cytokines (e.g. tumour necrosis factor alpha) and the expression of a number of receptors…

      • hi Tatertot, well i’m enjoying my first bach of green plantain chips, cut 1/16th inch thick,warmed in oven at 120F for 2 hours. assumed ready when they snaped rather than bend??????.
        added salt and flaxseed oil. hope this helps with FBG.the chips from 1 plantain only weigh 2.5 OZ so how much RS is there????

        • I’m glad you weighed them, I was curious what a dried plantain weighed. 2.5 oz is 73g, so I am estimating there would be about 65-70g total RS.

          If using oven, I would preheat to 120, insert chips, turn oven off after about 20 minutes and let them dry in the cooling oven, although I doubt 120 degrees for 2 hours would convert any of the RS to regular starch.

          They are ready when they crumble and break easily. If they don’t taste right, let them dry a bit longer, all the funky bitterness is gone when they are dry. Pretty tasty, right?

          I have been eating a big handful first thing in morning on an empty stomach, kind of a light breakfast as I drive to work. I figure this gives the RS the best chance to get to large intestine where the magic happens.

          If you want to give it a really good try, eat 1.25 oz (36g) every day for 3-4 weeks. There is no protocol for best time or anything, you’ll just have to do what easiest for you. An after dinner snack would probably be just as good as morning meal, as far as I know.

          If you like to read studies, here’s one that concluded: “These results suggest that dietary supplementation with resistant starch has the potential to improve insulin sensitivity.”

          And here’s an article about colon health, so even if your FBG doesn’t budge, rest-assured what you are doing is all for the greater good!

  6. Can anyone help? I’m not having success hunting down an older post re: magnesium for menstural cramps.

  7. Hi Paul (or anyone else who can answer), I have a question about copper and one about Iodine. I’m a little scared of these supplements so haven’t started them yet.

    So, my intention is to eat liver once a week but find that I can’t always get it, don’t have time to make it (my family refuses to eat liver, so this is something I have to make just for me) plus I haven’t really found a recipe I like yet, in short, the real is not living up to the ideal.

    My question is, is it dangerous to alternate copper supplementation and liver consumption on a week to week basis? Say, if my goal is to eat liver every Monday, if I for whatever reason I didn’t eat liver one week, could I then take a copper supplement on Monday instead without getting in danger of overdosing myself? Or vice versa? If I normally take a copper supplement, but one week wanted to try a liver recipe could I just not take my copper supplement that week?

    For Iodine, you’ve talked about how important it is that your thyroid has regular levels of iodine to draw from. I am a somewhat forgetful person, if I got into a habit of taking a regular dose of iodine (working up slowly) and then forgot one day, or two days, or one week, is that really bad for the thyroid/my energy levels? If I forgot one week and then started again, should I go back to my previous dose or start with the lowest and start gradually increasing again?

    Sorry to ask these picayune questions. Thanks in advance.

  8. Hi Paul,I was going to start to ferment my own veggies using a mason jar,sea salt to taste,veggies.Leave out at room temp for 7-10 days.Easy enough?Or am i missing something?

    • Paul has said it works fine. You can get fancier with Pickl-it vented jars or water-sealing vented crocks but don’t need to if you don’t want to.
      Paul likes to ferment for about a week to 10 days max. so dead bacteria don’t have a chance to accumulate to any degree.
      This guy http://www.wildfermentation.com/ is a fermenting nut and says fancy equipment isn’t required. Keep the jar in a dark place.

  9. Thanks Jack

  10. I cooked my plantains at about 100 for a few hours and I dried them out too much,they taste good but don´t over cook then or they get too hard.

    • I hope you mean 100 deg F! 100 deg C is waaay too high and would destroy the RS. I really think it’s fine to just air dry them for 24-48 hours, there is very little moisture in them. Cut thin, put on a cookie tray and turn them every 6-8 hours. Taste them as they dry–you will know when they are ready! I have never had any get too hard to eat.

      • Tatertot,
        I’v found this on the web : http://store.orkos.fr/fra/banana-plantain-dried-cameroon-1.html

        Those bananas are described as plantains,that are dried under 100°F,and that can be eaten like “dried fruits”.. Can the recipie you gave be considered the same ? Are the plantains you air dried, look the same ? (the photo looks like it tastes caramel ! ) 🙂
        Anyway, Thanks for your good ideas !!



        • The plantains I use are very green–the ones in the link are very ripe. The RS disappears as the plantain ripens–I would say the ones in the link have almost no RS left. But they look AWESOME!

  11. Yep 100F. I will air dry next time.

    • Maybe try different thicknesses, too. You may have made them a bit too thick.

      • Hi Tatertot-
        What a great idea. I headed to Whole Foods today and bought four plantains. Sliced them thin, salted, and air dried them on wax paper initially. Our oven minimum temp is 170F. So, pre-heated oven, opened door until a cooler and placed the slices on cookie sheets. A bit rubbery still, so will let them sit until tomorrow. Mulling the idea of using the dried chips with olive oil and seasoning of some sort. You have struck upon the motherlode of RS. Nice work.

  12. Hi Paul,

    I’ve been following PHD for a while now, improving every day but do you have any idea about what kind of probiotics to take? Fermented foods never agreed with me and I’m not sure why.

    These are my Metametrix Stool Test results: http://www.use.com/b198b5a86852af87a9e0
    (Scanned documents into image files)

    I have very little good bacteria and an overgrowth of Aeromonas, which I have no clue about. No yeast/parasite problems so I’m not sure why I have problems with fermented foods. Is it the lack of other good bacteria in my gut that doesn’t allow me to fully digest the fermented foods? Should I stick to supplements for now?

    Thank you!


    Of course anyone else is welcome to chime in!

    • Hi kimanyd, It looks pretty good to me. I would probably focus on eating a variety of vegetables and types of fiber, especially in-ground plants such as carrots and beets, resistant starch sources like potatoes, fruits and vegetables and berries (eg tomatoes), some stalk vegetables like celery. I don’t know what probiotics to recommend, I think fermented vegetables are the best probiotic.

  13. victoria forsyth

    Does anyone know why tallow and other animal fats do not appear to have any significant vitamins? Or is that a myth?
    Because I thought high fat meat was supposed to be the best source of fat soluble vitamins. Or does rendering fat seperate the fat from the vitamins?

  14. I love to eat platains,but they do tend to make me gassy.Is this a normal part of the digestion process?I have amped up my consumption of fermented veggies and probiotics with no help in my issue.Would it be possibly that refrigerating the platains overnight then recooking them will help to break down the resistant starch so that i can better handle them?

    • I’ll take a stab.

      If you are using very ripe plantains, it is more likely the fructose content that is causing the gassiness. Do you experience same with ripe bananas?

      I’ve never heard of anybody having trouble with resistant starch. If you are eating the plantains cooked and hot, there is almost no RS in them. Even cooked and cooled have very little. The most RS in a plantain is when it is still very green and raw.

      Try choosing the greener plantains and sautee in butter until very tender. If you only like very ripe plantains, you may have to deal with a possible fructose malabsorption problem. A good test for fructose malabsorption is to eat a large, peeled pear and see how much gas develops. If there is none, you are handling fructose well, lots and you have a problem.

      • Tater,

        Do you know at what temp does the potato lose it’s RS? Isn’t there still some RS in a hot potato?


  15. Hi Paul,

    I am really enjoying reading your book and in some ways it has made me more relaxed and confident about the foods I feed my family.

    I have a question concerning my 8 year old son. He is an extremely picky eater and lacks a healthy appetite, I’m not sure why he’s this way but from what I can tell he does have issues with sensory processing disorder. I am not sure if he’s on the autism spectrum but it’s possible- he is very intelligent and thinks very different from a typical 8 year old. he would rather play with his lego robots rather than be ‘interrupted’ for a meal.

    I am just wondering what I can do to help him and to make sure he’s nourished. his diet consists of only meats (chicken nuggets, breaded veal) and carbs (pasta, rice, bread), he drinks goats milk, apple juice and is able to eat chips, crackers. He also loves chocolate and will happily eat nutella. He is reluctant to eat anything that I make from scratch so most of what I buy for him is store bought.

    I recently read a book where they suggest that gluten and casein has some negative effects- I am trying to wean him onto less gluten however he will happily starve himself rather than try different foods.

    I did work with his Dr. on a ‘starvation inducement’ however I gave up after a week because it was just too painful for me to see him so hungry and he wasn’t willing to eat new foods- even at his hungriest.

    I am wondering if you have any suggestions on supplements or other ways I can make sure he is properly nourished. I am hoping that he will ‘grow out of this’ one days as I’m told by other parents who have had similar issues.

    please note that we are a healthy household.. i make most of my foods from scratch and my other 2 children eat very well and as parents, we try to set a positive example for them. i am also trying not to make this an issue at the dinner table and turn this into a power struggle.

    thanks so much in advance!

    • Hi Christine,

      perhaps http://parenting.stackexchange.com/questions/102/how-do-you-feed-a-picky-eater would be a better forum for this.

      So he really didn’t eat anything for a week? Note that after a day of not eating my hunger subsides. Perhaps try one last serious sugar bomb which may induce more hunger afterwards, to be quenched only with whole foods?

      • thanks for the link.. i’ve read most of the typical advice and while it will pertain to my two ‘more normal’ kids it won’t work for my ultra fussy oldest. he will literally starve himself. he just has no interest in foods or appetite. i feed him what he’ll eat mostly because i don’t want to make things more stressful for him (and me) and it to become a power struggle. he already knows it bothers me and when he’s angry at me will refuse to eat just to spite me…
        i have tried the sugar spikes too.. it works with me.. doesn’t with him 🙁
        i’ll read over the link again.. maybe find something useful.. most advice i’ve followed, read.. been dealing with this for 6+ years and have tired almost everything.

    • Hi Christine,

      It’s certainly a challenging situation, unfortunately I don’t know much about how to deal with it. I would continue to try to substitute healthier foods — eg potatoes for pasta/bread, perhaps as homemade French fries or sweet potato fries; and try to create dessert-like foods in which you sneak nourishing things — ie make homemade ice cream with mashed potatoes and bone broth and cranberries mixed in. He may develop a taste for some of those things.

      • Thanks Paul- that is what I’m working towards.. trying to get him to eat rice cooked in bone broth, chocolate popsicles with avocado etc..

        I guess what I am concerned about is- with such a limited diet what nutrients might he be lacking completely? I’ve read that zinc can play a number on appetite and if/how I should supplement zinc and what about copper etc?
        Also- he gets a great deal of omega 6 as the oils he eats are not great.. can i supplement him with fish oils? he does like the lemon cod liver oil strangely enough.
        Also- i don’t know if there is anything to the starvation diet.. but his immunity does seem good and he seems to get colds the most infrequent compared to all of us.
        Thanks again for taking the time to reply!

        • It might be good to track his food for a week and log it on CRONOMETER or nutritiondata or some similar site and then compare his nutrient intake to PHD recommendations. That would give you some insight into possible supplement needs.

    • Hi Christine, have you read the book What’s Eating Your Child? It’s a good place to start for figuring out how to untangled pickiness from problems and to link specific foods to sensitivities. Just reading the other case studies is helpful, and she gives some great advice and little nuggets of information along the way that might help you.

      In my experience with my kids, eliminating wheat and sugar, esp. and to a lesser extent dairy, makes them more willing to try other foods.

      • I did read that book! or maybe about 3/4 thru it. it really makes sense.. and I plan to cut out gluten/dairy in the summer again. my first attempt was during this ‘starvation inducement’ which was a fail and made me feel that i lost trust with my son. my doctor discouraged me from trying it.. saying there is ‘no proof’ etc. i was discouraged but from what i can tell he does react from some foods negativity (behaviour-wise) so i think there is something to it.

        i am waiting for him to regain some weight, strength and confidence around food.. and hopefully in the summer when he’s active and home from school i can focus on better foods. it shouldn’t be too difficult for me to cook since I am GF and now follow the PHD. The whole family is gluten light and pretty much eat what I cook. I do worry he’ll just let himself go hungry but I’ll make sure his weight is monitored at the very least.

        Thanks for your comment Elizabeth and if you have any more experience in regards to this please feel free to contact me.

        • Hi Christine, I’m not sure about this but I was thinking it might already be a power struggle. You could try taking the focus of food and make him go to bed a half hour before his siblings. He will probably sneak one of those handheld gameboys in and feel like he has won. Then you can just provide 2 options at each meal, what he wants & what you would like him to eat, and leave it up to him. He might need the power struggle at bedtime because he’s not a happy chappy (because he eats crap lol but that’s his choice). ~EttaB

  16. I know that statins are frowned upon, but is there any prohibition to taking a low dose while pursuing the PFD? Is there any “danger”, for example, to your liver in doing this?

  17. Hello Paul and others!

    So, I have been working with a functional medicine doc for the past few months which means a lot of blood tests. Over the course of 1 month my LDL jumped 50 points, which obviously increased my total cholesterol. My HDL remains “high,” and good at 68, but this jump in LDL concerns me. I know these numbers can fluctuate a bit, but that seems extreme! The only other noteworthy thing on the test was a drop in WBC… it dropped almost a full point making it below lab ranges. I think I recall reading somewhere, sometime that LDL somehow modulates infection? So, could it be that I was exposed to something and that caused the LDL to jump? I searched the site, but couldn’t find the article I was thinking of.. and I am actually not sure if it was here I read it in the first place!

    Anyway, thoughts?



  18. Hi Paul-
    I was wondering if you could clarify a quick point for me- when you say approximately 600 calories or 160 gram of carb per day, is that “total” carbs or “net” carbs (ie with fiber subtracted)?


  19. Hi Paul,
    Can i make bone broth using 2-3lbs pf bones,2tablespoons of apple cider vinegar,cook 24hrs in a crock pot?Thanks

    • That’s my typical recipe and it’s worked great for me. There are a couple important steps however. I usually start my broth in a large pot on the stove and I bring it to a boil and then sustain a low boil for 15mn or so. A lot of scum will build up on the surface, you don’t want this in your broth. I then strain out the water and transport my bones to a crockpot that’s been pre-heating. Then I’ll fill the crock pot to the top with heated water from my electric kettle and stir in the vinegar. I also like to add peppercorns, salt and a few garlic cloves and yellow onion cut in half. After 24hrs or so, strain the broth and allow to cool before placing in the fridge. Good luck!

  20. Can someone simplify the portions for me? I just can’t seem to picture 1 lb of rice or 1 lb of meats. Is there anyone on this diet who can share what they eat in a typical day?

    • Nutritiondata.com can help.

    • I highly recommend a new digital scale. It has a ‘zero’ button. 🙂

    • Want to try something easier? Just make meat, veg, and starch the bulk of your daily eating habits. If you find you are gaining weight, tweak down a bit in one or more of the areas, like not so starch or meat…

      The harder you make it, ie. weighing everything, the less likely you will stick with it.

      When you start tracking individual macronutrients, it becomes very cumbersome.

      I tried it at first, eating exactly 1 pound of meat, starch, and veg w/added fruit, eggs, cheese, chocolate etc…I found I was gaining a bit faster than I’d hoped, so I quit putting sour cream on my potatoes and stopped eating nuts after dinner, and my weight leveled off nicely.

      Anymore, I don’t really track the weights or try to equalize, but every lunch (I skip breakfast) has a portion of seafood, large salad with a variety of veggies and a small serving of starch. Every dinner has a larger portion of meat, a good sized portion of starch (rice, potatoes, plantains, etc), and often a piece or two of fruit. If still hungry, I try to go with very healthy snacks–egg yolks, dark choc, etc…

      The main takeaway is don’t limit any one food item in an attempt to maintain weight, or stay healthy–eat them all without stress.

    • When visualizing dense food like meat or potatoes, think about what a pound of butter looks like. It’s close enough to the same amount.

      • Thanks all for your posts! It’ll get me on the right track. Thanks again for taking the time to respond 🙂

        • I, too, purchased a kitchen scale when I began navigating the first book, as everything was in grams and pounds. Use that scale everyday. Love it to easily portion out pot roast, salmon, and potatoes when getting my lunches prepared ahead of time. The references in the new book to “fist-size” are a bit troublesome because I’m so used to the precise measurements. My scale can provide lots of info about the food — I enter a code and get much of what is listed on those websites.

    • Also I don’t understand how rice and potatoes can be considered the same. A pound of potatoes have about 95 grams of carbs, and a pound of rice have about 130 grams of carbs, according to nutritiondata and my google spreadsheet.

  21. My general strategy….
    1. Eat approximately 1 large sweet potato per day or 2 small white potatoes(of course adding a fat such as coconut oil or butter or both)
    2. Drink 2 cups of coffee blended with 1-2 tablespoons of coconut oil (I also add cinnoman)
    3. Eat enough meat per meal to satisfaction (fattier the better, such as leg of lamb, rib-eye, ground beef etc)
    4. Eat a serving of fermented veggies per meal
    5. Drink a cup of broth with 3 yolks mixed in(sometimes I’ll add a tablespoon of tallow)
    6. Eat a couple carrots or beets
    7. Eat as many dark leafy greens as I can
    8. Add saturated/mono fat whenever possible (I’m skinny and need the extra calories)

    I’ve found that with this strategy I don’t have to perform calculations prior to preperation or weigh my foods and randomly when I do weigh and measure I’m generally pretty close to Pauls recomendations. In my opinion we shouldn’t be too paranoid about hitting the macronutrient ratios dead on at every meal. Perhaps those of us who are sick or elderly should attempt to be more strict about it.

    I would also add that perhaps when you first start the diet you may want to weigh and measure your food but after a couple weeks of experience you can probably get pretty close to the macronutrient amounts without weighing.
    Hope this helps!

    • Oops, this was supposed to go under Christine’s question.

      • Thanks Jonathan- that is a big help! Thanks for taking the time to post this.

        • It is a bit tricky at first, but having a kitchen scale can be helpful when you’re getting started. A pound of potatoes is generally 3 medium-2 largish. For meat, generally a fist sized portion is 3-4 oz.

          I think it is always best to start with Paul’s recs and adjust for your tastes and activity level. I am very, very active so I am constantly trying to eat more carbs. This can be tricky.. and can get a little boring, so I do eat a fair amount of GF bread that I either make or I generally kill myself trying to find brands that don’t use crappy oils. Here is what a typical day for me looks like:

          Meal one: A banana and 3 eggs, sometimes in a rice tortilla.

          Meal 2: Leafy greens with vinegar, some kind of protein, carbs.. generally leftovers like pasta or potatoes or bread. An apple, maybe some berries, glass of kefir.

          Meal 3: More carbs, rice pasta, potatoes, etc. More meat, more veg.

          Meal 4: dessert of some kind.. ice cream, chocolate covered bananas, gf cookies, etc.

          Somewhere in there I eat another banana and fermented veg,

          I try to add little fat to my food as I prefer higher carb lesser fat.

          Also, an app like fitday is really, really helpful if you’re not used to being aware of intake.

          I hope this helps!

  22. Hi Paul,

    My son seems to exhibit several symptoms of Chronic Fatigue Syndrome (minus the fatigue). He has chronic headaches, swollen lymph nodes and muscle pain.I am slowly getting him to eat PHD most of the time. I read that sometimes amino acids can make a difference with symptoms like these, however there are so many to choose from. Can you maybe recommend one that you think would be a viable option? (He has been tested for infections, etc, but all his tests come back negative). We want to experiment with different things to see what might benefit him.

    Thank you for your time,


    • Hi Laura, I thought I’d go ahead and give you my best answer while your waiting for Paul. I’ve been meaning to write a reader result report on this subject, I’ve had fibro(very similar to cfs) for 6-7 years and I’m now 80% recovered and feeling better every week after eating PHD, taking recommended supplements and following the circadian rythm protocol for 3-4 months. Keep in mind that only 5-10% recover from this illness.

      Latest research is pointing to the gut as being the starting point of the illness. A recent study indicated that 42 out of 42 fibro patients tested for SIBO came back positive. I think the control was around 20% positive. I’ve also read a number of reports of people gaining full recovery after recieving a fecal transplant. It’s all in the gut!

      Before you go getting your son tested for SIBO etc, you should get him on 100% PHD along with recommended supplements for at least 3 months. There are too many examples to list, but the PHD diet is perfect for combating hidden infections and restoring gut health.

      Your son may find that after a few months on the diet he is symptom free or at least much improved. If he still has CFS symptoms, you may want to look into the following tests to see whats going on in his gut. I would get these tests performed even if he doesn’t complain of digestion problems or stomach pains..
      1. SIBO (hydrogen breath test)
      2. Hypochlorydia
      3. Leaky Gut
      4. Complete stool analysis

      These tests may help you pinpoint the root cause and after 3 months or so on PHD, if antibiotics/antifungals etc. are needed, they should be more effective than if your son was on a poor diet.

      One last thing, something that helped me with body/muscle aches, pain and weakness was strength training. He should start slow and light and build up slowly.

      I would also suggest you check out phoenixrising.me , their forum is fantastic and the members are extremely knowledgable. Many of the members of the forum have taught themselves how to read complex studies and papers and have learned a great deal about this illness. It may also be a good outlet for your son so that he can share thoughts and experiences with other cfs sufferers.
      Good luck!

  23. Hi there readers,

    How would you adjust this recipe – see link http://www.gourmettraveller.com.au/potato_and_cabbage_gratin.htm
    To make it phd acceptable. I’m assuming the sugar needs to be reduced and breadcrumbs can be omitted. I had this in Neil Perry’s restaurant and it is yummy.. I’m sure an adjusted version would still be delicious

    Thanks in advance!!

    • Just skip them both completely. No need for sugar at all, especially if you have a good quality cabbage. They are sweet for goodness sake!!!!!

      If you really want that crunch, you could try some rice cracker crumbs.

  24. Hello Paul,

    this is a statin question

    imagine a case where LDL-P is 2300, and hdl 70, TG 70, and TC 300

    thyroid tests all normal
    PHD toxic free diet
    all supplements
    10% body fat
    45 yr old male
    BP 120/76
    IR (insulin resistence): 10
    LP(a): 7

    In such a case, what would you imagine the risks of taking a statin to address LDL?

    Also, what is the risk of not taking a statin with LDL of 180, LDP-p of 2300 particles? Are all the other lipid characteristics enough to protect (high hdl and low TG)?

    btw: i noticed that perhaps 30% of low carbers (5-20% carbs by calories) face a similar situation)

  25. Paul, i found this,
    and in this analysis (i can be totally wrong, very technical) it centers around lower LDL levels, so, i go back to my original question, for real high LDL, are statins needed?

  26. Hi Paul,

    I’ve been a vegetarian for 37 years. I’m allergic to dairy, but don’t seem to have much of a problem with raw goat milk cheese, which I eat occasionally. I like eggs, and usually have 3, poached or medium-boiled at a time. I use coconut oil (often), olive oil (often), and occasionally red palm oil . I use chia seeds regularly for their high Omega 3 content, along with all their other nutrients.

    I’ve been mostly raw for the past 6 years, sometimes having baked potatoes, yams, rice. I eat a lot of greens – kale, spinach, chard, mixed greens, etc.

    My question is, can I successfully follow your eating plan? I don’t want to eat meat, liver, fish or bone broth.

    I plan to get your book, even if it’s not particularly for vegetarians, because of all the other insights and information it contains, but did want to ask about the vegetarian thing. I’m new to your site, and apologize if this has already been addressed.

    Thank you for your help.

  27. Oops, too late, Jonathan — I bought the 2nd edition kindle version about 20 minutes ago.

    I’ll see if I can find a used 1st edition. Thanks for letting me know, though. I can probably use the 2nd edition, since I do eat eggs and raw goat milk cheese, right?


    • Sorry about that Ronn! Yes, it should still be applicable. There are other suggestions outside of diet that you may want to follow such as eating in a 8-hour window, enhancing circadian rythm etc.

    • Hi Ronn,

      Check out what Paul wrote here: http://perfecthealthdiet.com/buy-our-book/comment-page-5/#comment-131227

      Basically, make sure you avoid the standard protein sources (soy, wheat) since they are highly toxic. You could stay on the low side of protein requirements and eat only eggs and cheese.

      Also consider seafood – highly nutritious and not very far on the evolutionary ladder. Then there’s also land shrimp but that is harder to get. 🙂

  28. I was thinking it would be great if Paul could give a presentation at TED.

    Since he’s in Philly this weekend it would also be great if he stops at the WHYY station and suggests himself for an interview with Terri Gross on NPR’s ‘Fresh Air’ program.

  29. Paul

    Whenever u get some time kindly let me know if ivermectin is safe during nursing? Does it work for protozoa infections too?

  30. Hi, I am reading your book and have some questions about the ketogenic diet to manage my 17-year old son’s ADHD (we have never medicated) and, more pressingly, to heal and protect from long term effects of back-to-back concussions. I am unclear on how to meet nutrient requirements (eg, potassium) while eliminating all fructose foods. Also, what are your thoughts on supplementation with DHA for the ADHD (some research indicates deficiencies)? Thanks!

  31. Hi Paul,

    How does Leucine help with Keto diet? Is it beneficial to take it after meals to increase protein synthesis?(while on Keto)

  32. Wout, thank you very much. I appreciate that!

  33. This article (from the Vital Choice website -great wild salmon etc) disses the Paleo approach, but the authors use evidence from early agricultural societies, not hunter/gathers/ Worth a read, anyway.


  34. Hi Paul:
    I forgot to mention in a previous question to you, that if someone has high cholesterol, what are your views on taking ‘Red yeast rice capsules’ as a deterrent against high cholesterol?

    Your thoughts on this are appreciated Paul,
    Many thanks!

  35. Dear Paul,

    Intermittent fasting is wonderful. we are happy with our 16hour window, but we like to eat 85% chocolate after our diner at 19pm, up to 30g. are we still getting the benefits of intermittent fasting? is it better to eat no chocolate after fasting time started…?

    Thank you!

  36. Hi Paul,

    What are your thoughts on teff flour (http://en.wikipedia.org/wiki/Eragrostis_tef) in terms of toxicity? On the spectrum of safe and unsafe starches, where would you place it? Thanks!

  37. Hello Paul,

    Thanks for your great book and website! I’ve searched a bunch on the site and on the web for info that could help with our problem, but haven’t found it (feel free to point me there if it exists).

    Our problem: My husband and I have gained weight (about 2-3% of our body weight) since starting PHD about 2 months ago.

    The details: we are both athletic (13% and 18% body fat) and active. We were eating paleo/primal for about a year before we went on PHD. We were NOT low carb, we ate sweet potatoes, potatoes, and some rice. When we went on PHD we didn’t change the carb ratio much and we are on the low end of your recommended carbs. We added all the supplements (though are still slowly increasing Iodine which we take it liquid form currently at 500 mcg).

    I can’t figure out why this would be happening. We’ve measured our body fat percentages using calipers and it seems to be similar to when we started, suggesting it isn’t fat. We’ve both started calorie restricting to lose this added weight, but it doesn’t appear to be working very well. I think we’ll give it another month before we stop the supplements. Is there a reason there would be an initial weight gain – would it go away eventually?



    • Hi Ali,

      If you’re not growing around the waist or adding subcutaneous fat based on caliper measurements, then it would seem to be either increased bone density (possible with better mineral/D/K2/C nutrition) or increased muscle, both of which would be good things, or possibly better electrolyte status preserving water. Alternatively, on the bad side, it could be a mild hypothyroidism (perhaps reactive to the higher iodine) or some other toxicity or leaky gut effect which got worse — though either of those would tend to increase your waistline.

      How do you feel? Better or worse?

      Since you came from paleo/primal and didn’t increase carbs, I’m not quite sure what you changed other than supplements. Can you tell me more? Exactly what supplements are you taking, and what foods changed?

      You could try getting a thyroid test at your doctor’s. If you make a single supplement change, try reducing iodine back to 225 mcg/day and see if that helps.

      By the way, some people have thyroid nodules and even 225 mcg/day might trigger hyperthyroid symptoms including weight gain and puffiness.

      I don’t think calorie restricting is appropriate, you are both healthy and slender and should be cooperating with your body rather than fighting it. Appetite is natural and signals that you need something.

      Finally, a last thing to be aware of is that in terms of health, optimal body fat percentage is around 15% for men and 20% for women. Super-lean is not best for health. PHD is optimized for health and may lead you toward those percentages. But the extra fat would be in lean tissue / muscle, not abdominal fat, and should reflect an improved body composition with eg a higher ratio of bicep/thigh/chest circumference to waist circumference. So you should judge whether your body standards may be erring on the “cut” side, and whether you want to optimize for health or for a cut appearance.

      Best, Paul

    • Hi Ali,

      I gained several kg since starting PHD 2 years ago, and it seems to be all muscle. My pants’ waistlines are too large and my upper pant legs too restrained. I also have visible abs and my upper body seems more defined.

      Maybe you should monitor bicep and other circumferences? I never bothered…

      • Hi Paul (and Wout),

        Thanks for your reply!

        Our foods stayed about the same: pastured ruminant meats, lots of veggies, sweet potatoes, rice (though slightly more now), fruit, cheese, yogurt, sauerkraut, eggs, fish, pork, dark chocolate, bone broth.

        We are taking basically all of the supplements you recommend (both the daily and weekly supplements) and hadn’t been supplementing at all before that. We started with 225mcg/day of Iodine for the first month, and just upped it to 500mcg/day a couple weeks ago. I have measurements (waist, hips, chest, arms, legs) and they are all about the same too. The weight went on pretty fast (I noticed it in a week or two) when we started supplementing. It just felt strange to put on pounds so quickly with no apparent cause. I did notice some puffiness, so I’m wondering if it’s hyperthyroidism/the Iodine? I have a couple of the symptoms of hyperthyroid (occasional irritability and trouble sleeping) but that doesn’t seem conclusive.

        You also asked how I feel: I feel pretty good – sometimes a bit more sluggish when working out.

        As for weight/body image, I appreciate your recommendation. I do try and take a functional approach to my body – I’m not trying to look especially cut (though I’m not devoid of vanity;). I’ve been at this weight or very close for years and years, and even put on fat after going paleo, but I do race bikes, so I’d rather not be carrying around extra weight.

        Thanks again,


  38. Hi Paul:

    One of the things you mention in your book is to eat fat and protein during day and later in the evening eat fat and starch with starch by sunset to support Circadian Rhythm. One of the things I’m struggling with is when I get home, it’s about 7-8PM. What foods for a meal would you advise? I have been eating yellow egg yolks with butter and coconut oil with supplemental MCT oil to make me full but I am getting bored of that every dinner. Plus that regimine is not very family friendly when trying to eat together as a family around that hour. I look forward to your persepective.

    • Hi Eddie,

      I recommend making every meal balanced in line with our food plate, with slight tweaks for time of day. E.g., you want to average about 30% carb over the course of the day but breakfast might be 20% carb and dinner 40% carb.

      You don’t need to eat extra fat like the yolks-butter-coconut oil-MCT oil — in fact it’s better not to. Eat balanced foods as in our food plate. Add just enough fat to optimize the flavor and make you want to have a similar meal again the next night.

      If you are getting bored, one possible reason is that your meals are too fat-rich and carb and protein poor. Remember, oils have 4,000 calories per pound and PHD plant foods usually 100-500, so you have to have a plant-dominated plate and small amounts of fat to achieve our ratios of 55% fat 30% carbs 15% protein.

      • I will follow your recommendation but by doing so, isn’t it contridictory to your advice given in the book since a balance meal would include a little meat protein:

        Food Timing P. 376

        “It looks as though fat and protein in the morning, starches and fat at dinner is a recipe for enhanced circadian rhythm.”

        Eating balanced would mean say at 8, the time I get home, to eat a little bit of carbs? According to the book, eat most of our carbs around sunset. 8 is passed sunset-time.

        Trying to figure out what seems like contridictions.

        • Hi Eddie,

          It’s just a slightly poor phrasing in the book. These adjustments are meant to be small tweaks, not major changes in the structure of a meal.

          • I’ve been working this out for several months, now, and what is working extremely well for me (48/m/5’11/172lbs) is:

            Breakfast: 1 small greenish banana or a handful of dried plantain chips

            Lunch: Large ‘dry’ salad (just veggies of all sorts, no dressing) and a serving of fish, sardines, or oysters

            Dinner: Meat and potatoes (or rice, plantains, squash) until full, a piece of dark chocolate and a piece or two of fruit, a handful of almonds, maybe a piece of cheese.

            I have no idea how many calories I’m taking in or the ratios, but I am loving this and weight is rock-solid!

          • 2 questions tatertot, if i may…
            1. when you say ‘greenish banana’ are you talking about a ‘normal’ banana, what some refer to as a dessert banana. The reason i ask, is because, where i live, plantains are also called ‘green bananas’ (& yes they are plantains.

            2. did you find you bowel transit time changed when introducing RS?…
            I ate dried plantain chips the other day for the first time (one whole small/med size plantain) & went a day without a bowel movement. very unusual for me.


          • When I say green banana, I mean an under ripe dessert banana. They are fairly edible as they are.

            I can’t say I noticed a transit time change. I have been targeting about 20-30g/day of RS for about 4 months now. I can’t say there is really any difference that jumps out at me other than maybe stool consistency from day-to-day and better tolerance of foods that used to make me gassy. I think most of the benefits of RS are ‘invisible’, ie. gut health. I figure I will do this for a year or so and re-evaluate, but it’s hard to quantify.

            I have found a really easy way to prep the plantains for drying: Cut off ends, cut in half cross-wise, cut in half lengthwise (you’ll have 4 pieces now). Roll the meat out of the skins, cut each piece in half again lengthwise (you now have 8 pieces per plantain). Place on tray cut side up and salt liberally with fine seasalt. Dry. Eating 4 pieces is about 30-50g RS.

          • Tatertot,

            When you make the plantain spears how are you drying them? (And how long does it take?)

          • Plantain spears–good word! Fits perfect.

            I have a wood stove and set the trays in front of it, they are really dry after 6-8 hours. I have dried some on the counter with no heat other than the 70 degree house and it took about a day before they were dry, but I left them out for 2 days before putting them in a ziplock bag. I like to just get all the moisture out so there’s little chance of spoilage.

      • I will follow your recommendation but by doing so, isn’t it contridictory to your advice given in the book since a balance meal would include a little (meat) protein at dinner time?:

        Food Timing P. 376

        “It looks as though fat and protein in the morning, starches and fat at dinner is a recipe for enhanced circadian rhythm.”

        Eating balanced would mean say at 8, the time I get home, to eat a little bit of carbs? According to the book, eat most of our carbs around sunset. 8 is passed sunset-time.

        Trying to figure out what seems like contridictions.

  39. Paul, what do you think about inoculating veggies with soil based organism supplements prior to fermentation? Is there a chance they will take hold and multiply and be more beneficial than wild fermentation?

    • Hi Jonathan,

      It’s a good question. I doubt they survive well in the anaerobic brine but it is a potential way to increase genetic diversity. There is an outside risk of illness but there is a chance of good things happening too.

  40. Hi Paul, I live on Dallas, TX so seafood, especially shellfish is not readily available and I want to add more fish, especially lighter varieties to my diet as I want to lighten up my protein. I can buy frozen cod, sole and mahi mahi from Whole Foods, or farmed trout and occasionally snapper from behind their fish counter. Out of these choices, what is your best recommendation? Also, is wild shrimp once a week too much? I have to order it since Dallas only gets farmed, and it gets pricey. And generally speaking, how much is too much fish on terms of mercury concerns, etc.? As always, I appreciate any advice. Thank you!

    • Hi Dede,

      All of those are good. The biggest concern with seafood is concentration of toxins like mercury in fish high on the food chain. Here is a list to guide you: http://americanpregnancy.org/pregnancyhealth/fishmercury.htm.

      You can eat any of the low omega-3/PUFA seafood/freshwater fish as much as you want — it is only oily marine fish like salmon or sardines that you need to limit. Cod and shellfish/shrimp are very low-fat — you can tell by the taste — eat as much as you want.

  41. Forgot to add that I do eat your recommended salmon weekly.

    • Hi Paul, I forgot a question in regards to my increasing the low omega-3/PUFA fish in my diet. Should I increase my selenium for this change? Also, I was thinking about changing my selenium supplementation to brazil nuts, rather than take a pill. I currently take 100-200 mcg per week of selenium.

      Thank you so much for your advice!

  42. Thanks a million Paul!

  43. Hi Paul,

    I have a question regarding what I believe is hypothyroidism.

    I have orange tinted palms and feet soles and a slight tint to my skin that people are able to notice.
    I’m always a lot colder than everyone else I know, especially during the afternoon. From around 11-3 my hands are very very cold, its very uncomfortable.

    During this time my energy levels are also very low. Towards the evening I feel a lot warmer and my energy levels are much higher, whereas in the morning I have difficulty getting things done.

    I also become very drowsy and tired after a meal with starch in the morning/afternoon, yet in the evening a starchy meal just gives me energy.

    During my sport practices in the afternoon, I seem to get an acid reflux feeling when I’m moving around a lot, any idea what could cause that?

    Those seem to be the predominant symptoms that I have. I also have difficulty gaining weight, which would be odd if I was hypothyroid I guess.

    I’m 18 years old and eating fully compliant PHD, around 200-250g of carbs per day from potatoes and white rice since I’m athletic. I was supplementing iodine and selenium for about 2-3 months. I was doing 12.5mg iodine and 200 mcg selenium per day and in the first two months I improved a lot, but recently it seems hypothyroid symptoms came back so I decided to stop and see what you would recommend. Should I start at lower amounts and progress slowly?

    I would prefer not to go to a doctor for this since he is the type to put me on some kind of medication the instant I say something is wrong with me. Naturopaths in my area are too costly for me to consider one at this time.

    Thanks a lot Paul! My health has improved tenfold since following your recommendations, but I couldn’t find any specific information regarding what problem I may have, considering that I was doing iodine and selenium.


    • Hi kimanyd,

      It does sound like some sort of thyroid/Raynaud’s/HPA axis issue as there is a circadian rhythm element to it.

      Maybe an endocrinologist could characterize this a little better for us.

      I don’t know what the orange tinted palms could be. If you eat a lot of colorful vegetables eg carrots it could be beta carotene.

      I think it’s good to drop the iodine. If you have not become hyperthyroid, then a steady intake of 225 mcg/day iodine and 200 mcg/week selenium should be good. If the iodine bothers you, have your doctor test to see if you are hyperthyroid.

      Use your doctor for diagnostic testing. No one can make you take medicine.

  44. Would anyone be willing to share their personal protocol for fevers? Not looking for doctor advice, just anecdotal.
    I think I have the flu and I was wondering at what point do you usually take fever-reducing meds? I don’t want to take them at all unless fever gets high, because I know the fever is helping to disable the virus. Currently my fever is around 102.5, but I feel pretty good considering. I have a normal appetite and am eating but not too much and taking about 20grams Vit C per day without any bowel symptoms.
    Anyway, what do you generally do? (mostly I want to hopefully be able to put my husband at ease because he’s worried. I told him I’ll probably take ibuprofen if it gets above 103.)
    Thanks for sharing your own experience! 😀 At least I’m still smiling!!

  45. My rule of thumb for reducing fever via meds is to only take them if you need them to sleep. Just because I think sleep is so important to healing.

    The benefits have to outweigh the bad parts.

  46. I’ve been on PHd for about 6 weeks now. About three weeks in I developed sudden burping/belching/flatulence that wouldn’t go away. It hasn’t gone away for the past couple of weeks and even without eating I have chronic and frequent gas issues and mild stomach discomfort. Haven’t had any gastrointestinal symptoms before this diet. I searched your website and the only post I could find was with regards to low carbers having temporary symptoms. My carb intake is about the same as before (just swapped wheat with potatoes) and the gas has been getting worse.

    Has this happened to anyone else? Has the supplementation/diet promoted bad bacteria/fungal growths? Did I just get a food-born illness by accident? Am I sensitive to potatoes and causing stress? Any ideas before I seek medical help (which will likely be telling me to stop my current diet).

    • Hi Peter,

      I haven’t heard of similar experiences but we’re dealing with living things (gut microbes) and strange things can happen.

      I would try cutting back on supplementation and see if that matters. Magnesium may nourish microbes, so may many other minerals and some vitamins.

      Potatoes have more fiber than wheat and you may be eating more fiber generally. You might see if switching to white rice improves matters.

      Once you clarify what change caused the issue, the ultimate fix will be to alter and diversify your gut flora. One step toward that is eating fermented foods.

      Let me know how things develop.

      Best, Paul

      • Thanks for the update and prompt response. I went to see a doctor this afternoon just in case there was something serious and he seemed to find nothing in general and recommend some prilosec (which I probably won’t follow through with unless you think it will help) I’ll definitely try those tricks.

        Btw, other than that the diet is going well. I lost over a 100 lbs last year via calorie counting but didn’t feel all that much better, so I sought a healthier diet, which is when I found your book. I mention this because while it wasn’t PHD (or healthy in general) I lost the weight eating about 140-160g carbs, 140-160g protein and attributed a lot of my success to never being hungry. I picked this macros semi-haphazardly but lost all the weight with those numbers. I guess the lack of hunger wasn’t so lucky after all since those ratios coincide nearly perfectly to those you recommended so I can personally vouch for its efficacy.

  47. Hi Paul,

    I have been Paleo for the past two years, but have recently been experiencing what I think are hypothyroid symptoms (missed period, weight gain, cold extremities, no libido, and an ovarian cyst (for the first time at 38 years old)). In searching the web, increasing carbs popped up a few times as being helpful and having read your first book, I went and picked up the newer version to try to incorporate some safe starches and thyroid supporting supplements. It has only been 2 weeks but I have gained additional weight, and am feeling mildly depressed and more tired. My question, can your body lose the ability to utilize carbs effectively after 2 years of low carb? Is there a way to assist in this transition? Since I was already eating a whole foods diet, I was not expecting to see a huge immediate improvement, like I did transitioning form SAD to Paleo, but is there any precedent for feeling worse in the short term? I’m supplementing with iodine, vit C and magnesium, I’ve been eating Brazil nuts for selenium, and I have been eating liver, shellfish, butter, and coconut oil regularly for quite a while. My main changes have been adding in the safe starches, fruits, and supplements. One thing I have noticed is feeling less hungry at regular intervals, but am afraid that skipping meals might lead to more hormonal stress. Thank you for your time.

    • Hi Nicole,

      Your body won’t have lost the ability to utilize carbs, but you probably picked up a gut dysbiosis (bad microbes colonized your gut) during your low-carb period. Now when you eat carbs it feeds the bad microbes and you get fatigue/depression symptoms both of which result from immune activity / inflammation.

      The hypothyroid/amenorrhea/ovarian cyst/cold extremities/lost libido are all starvation symptoms and are consistent with you eating too few carbs.

      Skipping meals will help your gut recover, as starving the bacteria once in a while gives your immune system an advantage. If you have adrenal dysfunction then that might inhibit you from fasting, but hypothyroidism by itself shouldn’t stop you from fasting — the key is to eat sufficient carbs/protein/calories during the daily feeding window, but it’s not necessary that the food be spread out over the full day. Thyroid hormone sticks around ~36 hours so hypothyroidism is not like adrenal dysfunction in which symptoms can become severe in just a few hours.

      These two problems — hypothyroidism and gut dysbiosis — are probably the most common health problems on low-carb and many have them. They are probably connected in that gut dysbiosis/inflammation contributes to the development of hypothyroidism. You just have to gradually try to improve the ecology of your gut.

      Best, Paul

      • Thank you so much,, I wasn’t looking at gut dysbiosis as a possible culprit, instead focusing on iodine and reading through all the hypothyroid articles and threads while adding in carbs to address the related issues. I’ll up my fermented veggies and try to stretch a couple more hours to get to the 16 hour fasting when possible. I’ll let you know how it goes after a few more weeks 🙂

  48. Hey Paul,

    I switched to PHD in about September 2012 after a very strict bought with GAPs. I added safe starches (mostly white rice, potatoes, yams), beef liver, zinc chromium/vanadium (once a week), NAC, and seaweed/dulse on top of the magnesium, vit C, and D I was already taking.

    I started getting really dry/cracking hands and feet with some calouses and a bit of yellowing. Any idea if this could be vitamin toxicity or something?

    Also still having issues with amenorrhea and doctor wants to put me on Provera to induce a period-any insights on how to avoid this? I realize my period became irregular when I stopped soy, nuts, and beans/legumes…any merit to any of those items that might be affecting my hormones? Thanks!

    • Hi Elyse,

      I don’t know what causes the dry & yellowing hands and feet. Hypothyroidism might contribute, have you had any thyroid tests?

      Amenorrhea commonly results from diets too low in carbs or protein or total calories — this stresses the body hormonally including adrenals. Is it possible you were undereating, either carbs or total calories, while on GAPS? You might still be undereating on PHD, and undereating can exacerbate hypothyroid symptoms in skin because thyroid hormone levels are reduced to conserve energy when it is scarce.

      You can test removing supplements, that’s actually a good thing to do routinely (ie go food only for a period to test whether supplements are helping or hurting).

      But my guess is it’s probably more related to taking a lot of calorie-dense and carb-dense foods out of your diet and not adequately replacing them.

      • I just had prolactin, FSH, and TSH tested, all came back normal but my cholesterol is very high (297, LDL 170 HDL 117).

        I was definitely too low cal and carb on GAPs, which I have been increasing slowly…at about 1970 cals a day on average and 100-150g starch, but I still have issues digesting so much starch (lots of bloating, some breakouts on my face). Your post above to Nicole seems to apply to me as well…I’ll cut back on the supps for a week and keep on upping cals/starches and hope that my hormones and gut issues correct themselves!

  49. 93-year-old Tao Porchon-Lynch has been named Guinness World Records’ oldest yoga teacher.


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