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!

    I have been faithfully sticking to PHD for one month and have seen drastic improvement! I am so grateful to you and your wife for the work and knowledge you have shared. I have 40 stubborn pounds to lose, scalp psoriasis, acne and other random ailments. I’m down 9 lbs, have more energy than I can remember and my scalp and skin have never looked better( if I do say so myself)!

    My question is involving rice syrup. That is my main source of glucose due to gut dysbiosis. The brand that I use is Lundberg’s and one tbsp is 18 g carbs. I mostly take 2-4 tbsp a day, making my “safe starch” carb amount 36-72 grams. Is this enough? I know I’m doing something right because my body is responding well but I don’t want to take too little or too much. I could barely stomach the stuff the first week but now? I look forward to it everyday!

    Thanks for all the time you put into this website and your insight. You are changing lives!

    God bless,

    • Hi Libba,

      That’s great news, thanks for sharing!

      I consider 50 g carbs the minimum amount compatible with health. So I would say what you are doing is OK, but ordinarily more carbs would be better. Of course with gut dysbiosis carbs may have negative side effects, and so minimizing carbs may make sense for the time being.

      I would try to introduce food sources of carbs slowly — eg eat a small potato or fingerling potato daily. That will provide a little bit of resistant starch fiber that can help remodel your gut flora. I don’t think you want to totally starve yourself of fiber, even if it produces mild negative symptoms. You need to cultivate a diverse diet so that you can acquire the good bacteria you need.

      Another issue is that you may consider using dextrose powder as an alternative to rice syrup. With the brown rice bran proteins and arsenic in brown rice having appeared as concerns, we’re leaning more toward dextrose powder over rice syrup these days. But the most important thing is that you enjoy your food.

      Best, Paul

      • Tip of the hat to you for your prompt response! I’m enjoying food and look forward to eating each day. This is the complete opposite of my eating pre PHD.

        I will happily add real safe starches and see how that goes. I was concerned with rice syrup having a “less is more” effect which is what prompted me to ask. I guess I will be shopping for some dextrose. I have several bottles of rice syrup for sale to anyone interested!

        Thanks again for your time and I hope you and the Mrs. have a wonderful day! 😀

  2. Hi, I am reading your book and am particularly interested in the ketogenic diet to help my 17 year-old son. He is diagnosed ADHD and currently recovering from back-to-back concussions. As a general stratgey, what are your thoughts on supplementing with DHA for the ADHD (some research shows deficiencies)? Specific to the concussion recovery, I am uncertain about how to “eliminate fructose foods” while still meeting nutrient requirements. Any other ideas for healing and protecting against the long-term effects of concussion? And how does this overlay with nutritional management of ADHD? Any and all thoughts are most welcome!!! Thank you )

    • Hi Melanie,

      Re DHA, it’s good, but I think it’s best obtained from fish (eg salmon, sardines).

      Fructose doesn’t need to be absolutely eliminated but all added sugar should be eliminated and carbs should come mainly from starches like white rice and white potatoes. Potatoes are best. He can eat as many vegetables as he likes.

      I would say good nutrition and good circadian rhythms are crucial. That includes exercise (without head impacts!).

      • Thank you for your reply! Currently my son will only eat tuna – any dosage suggestions for supplementing with DHA? Would you recommend a broader spectrum omega 3 + DHA supplement or just DHA in this case?

        Thanks again for all of your help!
        PS> On the radio program “Quirks and Quarks” March 23/13 found thruogh the CBC.ca website, there is a short interview on new research on a possible auto-immune response to brain injury.

        • here is the link.. I just listened to it…


          if this is correct, does it give credit to the theory of leaky gut and autoimmune?

          I have a personal interest in head injuries.. I was injured by a chiropractor and suffered with debilitating symptoms for years. I had to do the research myself but as it turns out I have a CSF leak as a result.. possibly in the inner ear (called a perilymph fistula or labyrinth fistula). Many ENTs are not familiar with this sort of injury or do they believe it exists. some who do recognize it feel that it usually heals on it’s own and that you cannot leak CSF thru it.. I beg to differ!!
          I’ve been piecing together the puzzle of my own health and I feel that was mineral deficiencies which caused slow healing and why the fistula didn’t heal. it causes my symptoms from hearing loss to anxiety, headaches, MS-like symptoms, poor balance, lack of focus etc. etc..
          From my own experience and from speaking to others with the same injury I feel that this is a common occurrence with head injuries or with activities which involve straining such as childbirth or scuba diving.
          I feel that some people are prone to this injury and there is a strong genetic component in the inner ear structure. also- there could be a diatary involvement such as a histamine intolerance causing an increase of CSF pressure.

          anywho- I don’t know how your son is doing but if you need the name of a Dr. who can test for this I will pass along his name. I consulted with him with my own injury.. fortunately I have healed enough on my own to avoid any further intervention… however, I need to manage my injury and avoid anything that increases intracranial pressure.

  3. I enjoyed the podcast with Aaron Olson. He straightforwardly asked several devil’s advocate type – but good – questions about the development of PHD that I hadn’t heard from other interviewers, and these allowed Paul to carefully disassemble quite a few doubts that the average person might initially have about the diet.

  4. I just read about fermented cod liver oil (FCLO to the “pros”) and I wonder what Paul et al. think about it. Apparently there are flavored versions for the less adventurous.

  5. I used to get migraines that went away after going Paleo/Primal two years ago. I started PHD about a month ago, first increasing my starches which I tolerated well. After I started the recommended supplements I began to get migraines again and they seem to be triggered by dark chocolate, which I have previously enjoyed without problems. Your thoughts?

    • Hi NL,

      Interesting. Maybe too much copper? The things chocolate may give you too much of are iron, copper, and manganese, and only copper is something we suggest supplementing.

      This paper suggests copper can be a problem via a zinc deficiency or excess relative to zinc: http://www.ncbi.nlm.nih.gov/pubmed/21530095.

      So you should probably stop copper supplementation and see what happens.

  6. I have recently started learning about the PHD diet and implementing the basic tenants.

    I have nerve damage and neuropathic pain and spinal cord issues possibly including arachnoiditis and conus medularis syndrome from trauma and a subsequent spinal surgery. Some of the damaged nerves include the lower thoracic nerves on the left that give me left flank/abdominal muscle pain. The surgery I had (L1 corpectomy = removal of my first lumbar vertebral body) also destroyed my sympathetic nerves on my left side. I take some heavy-duty pain medications and others for nerve related issues. The side-effects of the meds. have included severe constipation and bad reflux. The constipation has caused a prolapse of my lower bowel and bladder.

    I started this diet to see how it might help with my neurological issues, gut and general health.

    I have eliminated all grains except white rice, use the good oils/fats recommended and eat the protein sources listed in your book. I have drastically limited sugar intake but not 100%. 10 days ago I started taking all the daily and weekly recommended supplements (not the ones listed as optional) and the Raw Enzemes for women – just one capsule/day for starters.

    Last week I started to develop what feels like GI distress – sharp pain and pressure. At first I thought it was my nerve damage acting up but now believe it is might be my GI tract. Could any of the supplements be causing this – especially the enzymes/probiotics? It has gotten painful enough that I’m unable to go to work.

    Of note however is the fact that things are moving better in my bowel with more regular movements – first time in years – but also more gassy and with pain. Are my GI problems to be expected with all the changes? I’m afraid to keep taking the supplements since I have it in my head one of these is the cause, or maybe I need to continue and work through this!

    Thank you so much for your time, a confused newbie – Elizabeth.

    • Hi elizabeth,

      I don’t generally recommend taking enzymes. Those are therapeutic supplements which means they should be taken rarely, only if you have digestive/GI tract issues for which they might be therapeutic, because they potentially have negative effects.

      I think in general you should cut down on supplements, including removing all therapeutic supplements. Just eat food and maybe the most important supplements like vitamins D and K2 for a bit. Then, after your digestion has settled, try adding them one at a time to see if they are tolerated.

  7. Paul,

    Sorry to hijack your advice to Elizabeth, but I wonder what are the potential dangers of enzymes? They are often touted as simple, “natural,” solutions to digestive issues.



    • They help break down proteins/lipids/carbs from human cells and beneficial flora as well as from pathogenic flora and food. If you don’t have pathogenic flora and your food is getting digested properly, they can only do you harm.

      • Thanks for that information about enzymes! I had no idea. I have been taking supplemental enzymes for digestive problems that came up very suddenly (as it seemed to me, anyway) last fall. Can you recommend a place to read more about this?

  8. Hi Paul,

    I mentioned my hypothyroid problems before even though I had adequate selenium and iodine. Should I skip selenium supplementation all together if I’m getting 150 mcg/ug per day or should I supplement the 200 mcg per week just incase?

    I put in a day’s worth of food into cronometer and the only deficiencies I had were Calcium and Vitamin E. How could I get more Calcium into my diet and stay PHD compliant?

    Now regarding Vitamin E, I’ve read on a few sites that a deficiency can inhibit thyroid function by inhibiting the absorption of iodine and selenium. Do you know anything regarding this?

    Cronometer shows me taking in 3.1 mg in a day’s worth of good which is only 20% of a day’s requirements according to cronometer.

    Could this be the missing link? I’m just nitpicking things while I wait to schedule an appointment with my doctor for a Thyroid panel, hopefully sometime soon!

    Thank you for all the help!


    • Hi kimanyd,

      I think you’ll probably be fine with selenium either with or without the weekly 200 mcg.

      The best source of calcium is bone broth. If not that, then dairy and green leafy vegetables.

      Vitamin E is thought to protect against thyroid damage via its antioxidant effects, eg http://www.ncbi.nlm.nih.gov/pubmed/21406454. I haven’t heard of it promoting absorption of iodine and selenium.

      I don’t see any harm in supplementing low-to-moderate doses of mixed tocopherols and tocotrienols.

  9. hi paul, just discovered this paper on the benifits of B1 for diabetics. http://www.naturalnews.com/025136_thiamine_diabetics_diabetic.html
    do you agree with the use of benfotiamine B1 and what would a safe high dose be? thks alfred

  10. Hi Paul!

    I have a bit of confusion concerning dairy and am hoping you can clear it up for me. I think you have commented on this a bit before, but I can’t seem to find it when doing a search.

    My understanding is there are 2 main issues that people take with dairy consumption (outside of environmental or lactose intolerance) and they are IGF-1 and hormones. I am generally not concerned with IGF-1 as I understand it is not in itself a bad thing. However, I am a little confused about the hormone thing. Generally speaking I assume you recommend full fat dairy when it is consumed, but don’t the hormones reside in the fat content of the milk? I enjoy dairy and consume most of it from grass-fed, non homog sources, but when out I often eat full fat cheeses and such. Should I eat only low fat dairy products when non from a good source? Also, am I right to think that grass-fed animals (non feedlot) would be milked only in the first few months of pregnancy rather than the full 9 months like a feedlot animal thereby reducing the hormones in the end product?



    • Hi Lindsay,

      Steroid hormones are fat soluble but most others are water soluble. So fatty dairy has fewer hormones than whole milk.

      I’m not sure what milking practices are, they may vary by farmer. If you know the farmer who provides your milk you could ask.

      • Hm, so sex hormones would be present in fatty milk, but others would be present in what is left when the fat is removed? I did find some studies correlating milk consumption to hormone related cancers. They seem to implicate full fat dairy products produced by modern dairy farms.

        I guess the answer might be to only consume dairy at home!

  11. Dear Paul

    I am very frustrated trying to put together a eating plan I can live with Let me give you a little background

    First some stats:

    60 year old male, 6’2″ Tall, present weight 242lbs, Body fat 27.5% (according to my Tanita Scale)

    Workout program: 6 day per week divided into 2 upper body weight Circuit style training, 2 lower body circuit Days, and 2 HIIT sessions on a Concept 2 rowing machine.

    Current Diet Primal Blueprint (on this about 20 DAys): 1900-2000 Cals per day. With a average of 180 grams of Protein (from Whey and lean Animal protein) 90 grams of fat( coming from olive oil, coconut oil and the meats I am eating), 50-85 grams of carbs (, vegetables, 2 servings of fruit)

    I take a Multi vitamin, 2000mg of D, and some fish oil.

    Sounds good, that said I feel terrible, weak and tired. And I am not losing any weight

    Over the last 2 years I have lost 100 lbs (yes I was 320lbs) I did this doing 3 rounds of the HCG diet. Which is a VLCD (about 800 Cal per Day) I realize now after extensive research that this was not the best way to do it as I believe I lost quite a lot of Muscle mass as well as body fat. I think I also destroyed my Metabolism. In my present diet I am not able to lose weight and I feel terrible as well. I have read everything known to man on Nutriunt percentages and Cal requirements and it is all confusing as hell. I believe I need to get to 15 percent body fat which would mean a 30 lb weightless resulting in a body weight of 205-210.

    All this aside I am frustrated. I dont know how many Cals to eat and when I research it its all over the map. I like working out but I am not married to my present program. Where I live is a remote section of the southern Oregon coast and I have acsess to great farm fresh organic local food. But I need some help. I am reading Perfect health now and want to understand how it can work for me.

    So I need some guidence on how many Kcals to eat to support both my workouts and weight loss and what is the proper nutrient ratio’s

    I look forward to hearing you thoughts. Help!!!!!!!!!!!!!!!!!!!!!!!!

    • Wow you are definitely not getting enough calories. I eat about the same amount of cals as you and I’m a 5’5 115 pound female. You also might be exercising too much-try taking out one of the HIIT sessions. More carbs will take care of that fatigue, too. This calculator gives a great baseline for cals, but experimenting is always necessary. http://www.health-calc.com/diet/energy-expenditure-advanced

    • FWIW It sounds to me like you have put way too much emphasis on exercise. As Paul said in the book, exercise is a wellness tool, it is not a weight loss tool. I would imagine you have done some damage to some significant hormonal functions by over-exerting yourself and undereating.

      I would take at least a month off from the heavy exercise, perhaps just focus on slow walking for movement, and focus on hitting nutritional parameters (what those would be exactly is outside my realm. Actually, maybe this comment is even outside my realm but I thought I might help!). I would also politely suggest re-orienting your attitude toward exercise and just do what you enjoy — what Mark Sisson would call “play”. I say this as someone who has been obsessed with training in the past…. to the detriment of my good health.

      Good Luck!

      • Which is the very reason. I am writing Paul. Being new tp the Paleo type eating style it is all very confusing. I would not describe my training as excessive in fact it only takes under a hour a day and should not my nutrition support my activity level? I usually feel better when I work out on a regular basis. Hence my my confusion. Thank you for you help.

      • Grayson, your points are excellent, and this is just a quibble. Don’t take it seriously if you don’t want to.
        I’ve tried in the past to get exercise by doing something that I enjoy, and I’ve found that I enjoy sitting in my puffy chair – the one that gives me a backache from its crummy design – and watching netflix.
        Paul’s educated guess that we’ve evolved to not like exercise, due to our ancestors having to do plenty of it just in order to feed themselves, has finally relieved me of my inner turmoil about why I’m so lazy.
        Now, I get on my Concept 2 machine and then follow up with some Steel Bow work, and happily and proactively hate every minute of it. And I no longer need to wonder why.

      • Re exercise:
        It seems to me that even though exercise is good in the general sense that a completely sedentary lifestyle is unhealthy, it’s important to recognize that the term covers a large area much the same way the word eating does.
        Regularly practicing any old activity one is attracted to is about as likely to maintain a healthy body as habitually eating only one’s favorite foods and drinking whatever water is on hand. Most physical activities exercise only selected parts of the body at the expense, or even detriment, of other areas.
        It seems sensible that the way to keep the body in good condition is to design an exercise program which will provide an aerobic workout, exercise all the major muscle groups in a balanced way, safely provide stretching and flexibility of the body’s muscles, joints, tendons and ligaments, and take the proper length of time and frequency to perform. It’s possible but unlikely that one’s favorite type of amusement can satisfactorily meet these criteria, but on the other hand it’s quite probable that when a carefully designed program first produces a healthy physique, that body will then be able to function well at any of one’s chosen pleasure activities.
        Fun can provide some exercise, but in most cases probably not in the best or most effective way.
        So if we want exercise to be safe, healthy and effective, we should design it for health rather than for fun.
        And then have fun whenever we want to.

        • Obviously it depends on what your goals are.

          I’ve recently felt well enough to start lifting some weights again here and there, but a year ago I thought I could train hard (and strategically/systematically/”properly”) and a flare of my disease knocked me off of my high horse pretty hard. Currently I battle the desire to pick up where I left off on my squat an dead numbers — the progress I was making made me feel great, but in too short-term of a way.

          My point is that for many “broken” people — metabolically, hormonally, disease-wise — exercise can exacerbate when we expect it to cure. A scholium to the point is that exercise becomes over-exercise very easily. The commenter originally said he felt horrible. Six days training was perhaps part of a cocktail contributing to that feeling.

          Not sure where the sarcasm starts in your comment, but its all good. I just know that you must be kidding about all that sitting – I’ve of course seen pics of your buff biceps and you must be doing something right!

          • Hi Grayson
            Maybe I should have made the exercise comments as a new post rather than as a reply to yours – yours just got me thinking about it. Of course you’re right that one can’t do the ideal activity or amount of it when one is ill, and my comments were really directed at the general audience when they’re considering an exercise program.
            As for goals, I’m talking about health rather than athletic performance or some other goal, as Paul’s focus, I think, is on health. I think if one designs an exercise program carefully, modifies it only as is needed and sticks to it, rather than expanding or contracting it, over-exercise will not become a problem.
            What you call sarcasm is just me trying to be funny, while making the point that depending on what’s enjoyable to also be good for you is a very uncertain way to achieve good health.
            That guy’s pic on the web isn’t me. There are two of us with this moniker, believe it or not.

    • also, just real quick on the diet based on what i’ve read in PHD:
      -more fat, less protein (you really don’t need to be thinking about ‘muscle-building’), same carbs
      -fruit okay once in a while but carbs should be based on starches. also, don’t count carbs in fibrous veg as real carbs.
      -nix the fish oil and add more salmon/sardines

    • Hi Andy,

      First, it is not important how many calories you eat (because you do have the excess fat to supply calories). But it is important how many nutrients you get, including the macronutrients glucose and protein.

      I think you are too low carb, first of all. Eat more like 150 g carbs mostly from potatoes or white rice and I think you’ll do much better.

      Eat protein to taste. When you increase carbs you won’t need so much protein.

      You don’t need much extra fat but do eat oily fish (salmon or sardines) once a week.

      Importantly, you need to get lots of micronutrition. Liver, egg yolks, bone and joint broth soups, green and colorful vegetables, seafood. A few supplemental nutrients.

      Then, when you have nutrition nailed down, work on circadian rhythm factors. Buy our book and follow the advice there.

      I think those steps will clear up your issues, make you feel better, and re-start weight loss. But regardless, let me know how you are doing in a few months.

      Best, Paul

      • Thanks Paul I have bought your book and am about hallway through reading it. I will certainly take your advice and put it to work. I am new to all this and find it very informative but counterintuitive to what I have been told my whole life.

        But I am game. Thanks to all who responded

  12. Hi Paul,

    I am wondering about severe cramps I get in my legs at night / early morning. I have Crohn’s Disease, so there are probably many complicating factors, but here’s the general gist:
    -I supplement Mg Citrate thru natural calm, probably 200-350 mg / day
    -I supplement Zinc 50 – 100 mg / week
    -I am borderline anemic but have okay Ferritin levels (not sure if absorption issues or “hiding” iron from bacteria in ferritin form)
    -Maybe most important, I was eating an essentially keto diet for a few months (misguided attempt to ‘starve’ pathogens), but brought back carbs about two weeks ago once I admitted that keto wasn’t working, AND realized you had written so much about all that — thanks! Carbs are starches and mostly white rice, some sweet potato.
    -Despite that recent change, as well as getting a flare under control, the cramps persist, and are INTENSE!

    Any ideas would be very deeply appreciated. Thanks for being so wonderful!

    • Hi Grayson,

      It’s usually an electrolyte issue. Try:
      – Potassium — Tomatoes, potatoes. Have a tomato at breakfast and either a tomato or potatoes with each meal.
      – Salt — get a little extra salt.
      – Calcium or phosphorus — make bone broth soups and eat 3-7 bowls per week.
      – Low-dose lithium (2.5 mg/day) may also help but that will reinforce the need for adequate potassium and sodium.

      Best, Paul

    • I should probably add a couple more things now that I’ve had a minute to ruminate:
      -I don’t supplement Calcium as per your recs but I do drink bone broth fairly regularly
      -I don’t eat a lot of potassium containing items (I don’t think) although I do eat SCD yogurt daily. I have started to eat more sweet potato and I think it is agreeing with me just fine.
      -Again, who in the hell knows how much of these nutrients I am actually absorbing through my inflamed intestines (although my disease presents mostly like UC — more in the colon than the small bowel).

      Also, while I’m at it, I have been wondering about the iron issue. <ost IBD patients have low iron / anemia. I alluded to the question earlier, but I'll ask outright: In your opinion, is it an absorption issue or do you think it is that "hiding" mechanism that you have discussed in the book as well the infectious disease posts? A third option could be bleeding, but I feel like that would be noticeable.


      • woops — that last comment was written at the same time as your response. cross post!

        thanks so much for the response.

      • Hi Grayson,

        I think it’s both – first, gut microbes are eager for iron and if they’re in your small intestine, they get first crack at iron from food. Then what does make it into your body is locked into ferritin to make it unavailable to microbes in the body.

        Yes, bleeding would appear as black stool.

        I would ask your doctor to advise you on the low iron / anemia.

  13. Anyone know about the Cholesterol blood test numbers…

    My understanding was that the LDL number is usually calculated using a formula (Friedewald formula),
    see here for a calculator,

    Now, i’ve just seen something that says Total Cholesterol (Chol) is also a calculation,
    ie. Chol = HDL + LDL + Triglycerides(.20)

    Can that be right…Chol being used to calculate LDL…& LDL being used to calculate Chol.

    I’m not much of a mathematician, but that just doesn’t sound right to me.

    anyone know the real deal, care to enlighten me pls, thx.

    • Yup, it’s right. Calculating either one from the other is just rearranging the terms of the original equation, which is allowed by the rules of arithmetic. When you move any term from one side of the equal sign to the other you just change its sign (from minus to plus or vice versa)

      • but did you notice jack, that in the example i gave (which i think may be incorrect now*),
        only HDL and Trigs have been measured,
        so in my example there are two unknowns, Chol and LDL…how can you calculate Chol if you do not know LDL,
        & how can you calculate LDL if you do not know Chol.

        *update; i think it may vary from lab to lab (Country to Country) what actually gets measured. So i think it is more likely that Total Chol is usually measured, & not calculated as i initially speculated (after a google).
        for instance wiki says,
        “Usually, only the total, HDL, and triglycerides are measured.
        For cost reasons, the VLDL is usually estimated as one-fifth of the triglycerides and the LDL is estimated using the Friedewald formula (or a variant): estimated LDL = [total cholesterol] ? [total HDL] ? [estimated VLDL].”

        Therefore you only have one unknown, now that i can understand.

        So if any labs do calculate Total Chol, then i presume that those labs must actually measure LDL.

        • Whoops sorry, I see what you mean. Should’ve taken more time.

        • Re Cholesterol
          There was a study of 30,000+ people noted by Dr David Williams that found this empirical relationship between cholesterol numbers and systolic blood pressure readings

          those who maintained (LDL – HDL)/LDL lower than 1 – [.005(Systolic
          Blood Pressure – 50)]

          avoided heart attacks and strokes.

  14. hi there,

    a quick question? why cream and not milk in your coffee… I didn’t get the takehome message from the book that dairy was an evil?? i am planning on rereading the book so maybe i just missed it??

  15. Hi Paul,
    What do you think of this new article of Danny Roddy, (specially the role of carbs…) ?http://www.dannyroddy.com/main/2013/3/18/another-view-of-evolutionary-nutrition

    Thanks for your point of view,



    • Hi Judy,

      I have a hard time believing that carbon dioxide levels in the body depend much on what energy substrates you use. It will be driven by the interaction with hemoglobin and other carriers and by diffusion constants.

  16. Hi Paul,

    thank you for what you do. My question is about omega 6. I eat a lot of avocados (2-3 a day), 3-4 egg yolks, sometimes some olive oil. Even though I never eat any vegetable oils in any form and eat sea food regularly, the ratio to omega 3 is “not healthy”. Do you think it would be a concern? Thank you,

    • Hi Vlad,

      I don’t think the ratio has to be precise, as long as you keep omega-6 around 4% of energy or less and get an adequate amount of omega-3 (1% of energy is plenty). Those foods sound good.

      • thanks so much, Paul!

      • I think some examples are helpful to get an idea.

        4% omega-6 for 2000 calories/day is about 9 grams (2000*0.04/9), 7 grams for 1600 calories/day.

        4.8g 1-(304g) Avocados, raw, Florida (Food #5471, Data Source: USDAsr25:09039)
        0.6g 1-(17g) Egg, yolk, raw, fresh (Food #1228, Data Source: USDAsr25:01125)
        1.3g 1T-(13.5g) Oil, olive, Extra Virgin (Food #78791, Data Source: CRDB:00059)

        So, 3-avocados (14.4g o-6), 4-egg yolks (2.4g o-6), 1T-olive oil (1.3g o-6) is 18.1 grams or 8% omega-6. This is double the 4% limit and seems significant as a daily routine. Also keeping in mind that omega-6 can go higher with other foods like poultry, pork, nuts.

        Is it ok?

        • I would like to jump in here and request some more detail. The PUFA chapter in the book makes a pretty serious case about avoiding excess n6.

          I have a similar affection for egg yolks and avos — they’re so great! Maybe not as many avos as the original poster. Olive oil is out for me now. Anyway, I think a lot of people might be in this boat, and in general it seems like n6 levels can creep up on you.

          So, 8% — fast track to inflammation or can it be mitigated somehow?


        • Hi Mark,

          Good calculation. It looks like 3 avocados a day is too many. One a day, plus the eggs and olive oil, would be better.

          • Grayson,

            They really can creep up on you, but in general I favor PUFA from whole foods and avoid them in processed foods. I am of the ilk that if a food is whole, naturally produced, it is not that bad. So, yes there are PUFAs in chicken skin, but certainly there are benefits to eating the whole animal. I would just limit avocado to 1/day or maybe every other day, limit nut consumption and outside of that don’t get too caught up on the numbers!
            If you want to get a good idea of how much PUFA you consume on a daily basis you could log food on an app like Fitday. You can add a special section for yourself to track things like PUFA.

            Additionally, while I can see wanting to cut out olive oil, remember that it has other properties outside of just fat.. for instance it is a great source of polyphenols and is anti-fungal!

            Hope that helps.

  17. Hi Paul

    Just wanted to clarify, when counting carbs do you minus the fiber from the total carbs? I usually get around 175g of ‘total’ carbs but 15-20grams fiber from the potato,fruits and veg so that means I’v had 155-160g carbs ?

    Also, im curious to know what you do in the winter season for circadian enhancement if theirs no sun or you can’t take D (without fat for absorption) due to fasting in the morning. Would some exercise indoors be enough, and getting vitamin D later around midday with your meal be enough to enhance circadian rhythms. I also try standing most of the work day with some sitting aswell and keep most of my sitting time for leisure activities in the evening like at dinner and with family. That’s what I’m currently doing..


    • My life got easier when I quit counting carbs and started weighing potatoes or measuring out rice. I started off PHD eating 1 pound each of potatoes/1 pound vegetables&fruit/1 pound of meat along with some supplementals daily. It was easy to make slight changes based on hunger and weight after the first few weeks. Once you weigh the foods a few times, it’s easy to ‘eyeball’ it after that.

      I live in the North and take Vit D 5000IU/day with lunch from Sep-Mar and none at all rest of year and my Vit D level is usually between 40-60 all year.

    • Hi arian,

      1. Yes. Fiber doesn’t contribute glucose so it doesn’t count as a carb.

      2. Vitamin D capsules come with fat and they will be absorbed if taken fasting. A bit less will be absorbed, but they will still improve vitamin D status. But at the midday meal is fine too.

  18. Hi Paul, sorry for all of the questions lately, but I need a little clarification on weight loss version of PHD. I re-read the chapter and in regards to fructose, does it mean if one is trying to lose weight, to cut out daily fruit? Should one cut out fruit all together until goal is attained? Still foggy brained and need help understanding.

    Thank you in advance for your help!
    p.s. so excited to try the new kimchi recipe from Shou-Ching!

    • Hi Dede,

      No, you don’t need to cut out fruit! I think 2 or 3 pieces per day would be reasonable.

      • Yay! Great news! Thank you!

        • Dede – Here are my thoughts on using PHD for weight-loss:

          Implement the PHD as best you can. Eat according to your taste and appetite of PHD approved foods for 2-3 months. Track your weight frequently throughout.

          After you have determined whether you are gaining, losing, or maintaining on what you are eating, make some slight tweaks to further your weight-loss goals.

          If you were gaining, tweak slightly until you have maintained a steady weight for several months, then reassess your goals.

          Once you find the magical combination of PHD foods that you can maintain your weight effortlessly on, to lose weight, simply cut back a bit on one or more item that isn’t crucial to your health, for instance–cut out the nuts and cheese, cut out the butter or sour cream, eat 1/3 less meat or 1/3 less starch every day.

          Don’t make drastic cuts, just a bit at a time until you find you are losing 1-2 pounds a week. Massive cuts will not help you in the long run.

          Eating at a maintenance level for several months empowers you a bit in seeing that you can have all these good foods without gaining.

          • Thanks tater tot… So to clarify, if I eat a 1/4 lb of meat or fish at each meal (lunch and dinner), which I think I’m at the lowest end, should I reduce? Before PHD, I was very petite: 5’7 and 115 lbs. I’ve gained 6-7 pounds since starting last November. I have a very small bone structure so 115 was a great weight. So, my weight gain is showing up around abdomen and love handles and a little upper thigh. So, any more thoughts since I eat on the low side of macro? Occasionally I cheat with olive oil potato chis and ice cream! Maybe I should stop the cheating! Ha! Thanks again!

          • Great that you have been doing this since November, I was afraid you were jumping straight in for weightloss from some diet plan.

            I wouldn’t cut meat or starch to any lower than 1/2 pound each, that means you’ll have to ferret out some fat or sugar…potato chips, olive oil, butter, other oils, nuts, dairy are all easy targets that you shouldn’t miss too much.

            Maintaining can be harder than losing, find a sweet spot where you can maintain, then turn up the heat for weightloss.

            Of course, this is a simplified explanation of why you may have gained weight–there may be other reasons, so don’t blame it all on food if you start feeling miserable cutting some calories, there are lots of reason one could gain that aren’t explained by eating too much. Hopefully you have had the basics tested fairly recently, ie. thyroid, hormones, vit D, etc…
            Good luck!

          • Also, maybe the bigger elephant in the room, is maybe the fact that you are now at a more desirable weight. Also, winter is a time when many gain a few extra pounds, maybe keep doing what you are doing until mid-summer and see if you even out.
            Good Luck!

          • If I could recommend just one change though, it would be ‘stay out of the shadow of the apple!’

          • Dede, I think the timing of your eating is important as well. Try to eat less often during the day, and to vary your intake during the week. So if you currently eat 3 meals a day and also a snack, try to eat the snack with one of the meals, or if you currently just eat three meals a day, see if you can cut down to 2 larger ones. And vary your intake so 1 or 2 days a week you get a good, above-average intake, and 1 or 2 days a week you’re a bit short. Experiment and see what works for you.

          • Thanks Mark! I haven’t eaten 3 meals a day in years and rarely snack, if I do it’s fruit and not much of it. Sometimes I make a smoothie of fruit and egg yolks ice and a little water. I think I need more activity which has been tough with my painful osteoarthritis lately, as well as stopping the cheating with potato chips fried in olive oil and ice cream. I’ll cut the cheating and extra fat and try to move more and will report back with (fingers crossed) a success story! I appreciate everyone’s input so much.

  19. Hi Paul,
    I just got some blood test results back,
    I would love you to take a look over them & comment,
    I will post them in comments below, they cover,
    FBE, Lipids, Fasting Glucose & Ferritin,

    much appreciated, thx

    • Ferritin (20-300)…48 ug/L

      My ferritin seems to always stay low,
      & i never donate blood (not permitted because i lived in the UK during a certain period).
      The last few results have been (old to new) 47, 72, 56, (& now 48).
      The doctor did comment (in her experience) that this is low for a male.
      It seems interesting that even though i do not donate blood my Ferritin never seems to get that high….any thoughts/comments on this?

      Do my Haematology (below) give any clues.

      • Hi Darrin,

        I think that’s a good number. I don’t know why it stays so low. Mine gets down to about 35 immediately after giving blood and rises toward 70-80 before the next donation. When I didn’t give blood it was typically 150.

    • Haematology,
      Hb…..(130-180)….139 g/L
      – Hct..(0.4-0.54)…0.41
      – RCC..(4.5-6.5)….4.7 x10^12 /L
      – MCV..(79-99)……88 fL
      – MCH..(27-34)……29 pg
      – MCHC.(320-360)….336 g/L
      – RDW..(10-17)……12.9 %

      WBC….(4-11)…….4.1 x10^9 /L
      – Neut.(2.0-7.5)….2.4 x10^9 /L
      – Lymph(1.0-4.0)….1.3 x10^9 /L
      – Mono.(0.2-1.0)….0.2 x10^9 /L
      – Eos..(< 0.7)……0.2 x10^9 /L
      – Baso.(< 0.2)……0.0 x10^9 /L

      Plat…(150-400)….191 x10^9 /L

    • Serum Lipid Studies,
      Chol….(3.5-5.4)…5.6 mmol/L
      Trig….(0.1-2.0)…0.6 mmol/L
      HDL…..(> 1.0)…..1.8 mmol/L
      Chol/HDL(< 5.0)…..3.1
      VLDL….(0.1-0.9)…0.3 mmol/L
      LDL…..(2.1-4.0)…3.5 mmol/L (calculated-Friedewald)

    • Fasting Serum Glucose (3.4-7.7)…5.9 mmol/L

      • This is higher than one would expect. It should be below 5.5. It can be elevated due to eating too few carbs, or to some sort of prediabetes.

        • Thanks Paul,

          the lowest i have tested was with a
          Fasting Plasma Glucose of 5.6 mmol/L.

          & i was also tested at the same time for
          Glycated Haemoglobin (HBA1c). & the result was,
          Gylcated Hb (4.0-6.0)….5.0%

          Does that number shed any more light on things?

          • Hi Darrin,

            Not necessarily, but it is consistent with you’re being on a too low carb diet. It is a good HbA1c.

          • Paul,
            Just reviewing my carb intake, which i have not really been tracking for some time,
            My carb intake does vary between 100 & 150g p/d, sometimes higher.

            However, i note 2 things,
            1. it probably averages closer to 100g than 150g.

            2. & maybe around 50g of those carbs on average come from sugars.
            – 1 banana (sometimes 2) per day.
            – natural yogurt…far too much, i’m kinda addicted to the stuff. Sometimes this has some added sugar, & works out about 10-15g carbs per 100g.
            (i got rid of dairy milk years ago, but keep coming back to yogurt).
            – dark chocolate – 35g per day
            – macadamia nut & honey bar, occasional, 2 or 3 times per week.
            – misc occasional fruit &/or berries in the yogurt
            – organic carrot juice

            In the few examples i’ve given above, do those sugars count towards the approx 150g of carbs i should be aiming for per day.

            Or should i aim at getting 150g from safe starch carbs…plus my “sugar sources”, so i average more like 200g carbs per day?
            would that be an improvement, possibly.

          • Hi Darrin,

            Try eating 1 pound a day of white rice or white potatoes for about 500 calories from starch. That should solve the blood glucose issue.

          • thx Paul,
            I will have to put more effort in to getting rice/potatoes & sticking to it.

            Looking at my carb history, it seems i tend to trend back towards a lower starch diet without realising

          • Wouldn’t a pound of potatoes be 400 calories?

      • as a side note,
        regarding the testing on Fasting Sugar levels,
        Looking at my test history i noticed that the lab may use one of two tests (methods), either,
        Fasting Serum Glucose (fsg) – Lab Range 3.4-7.7 mmol/L
        Fasting Plasma Glucose (fpg) – Lab Range 3.4-5.4 mmol/L

        I am guessing which test they decide to run may depend on a few variables,
        collection method (container)/handling/price/other.

        Interesting to note that the ‘normal lab range’ for the Serum tests goes quite a bit higher than the Plasma test range.

        After a bit of google research this seems to be backed up somewhat by a few studies,
        “serum glucose has been found to be 2-5% higher than plasma glucose (R Gambino, unpublished observations).”

        “While plasma is recommended as the preferred specimen, some clinicians might be using results obtained on serum specimens (the liquid portion of blood after clotting).
        Serum intrinsically has glucose concentrations that are five percent higher than plasma.”

        • & if the result relates to the ‘concentration’ of the sample,
          then you would expect that
          Fasting Blood Sugar (fbg),
          ie. a full blood sample as taken by a finger prick,
          may test with the lowest number of the three,
          being the most diluted sample.
          (serum being the most concentrated sample).

          just a thought/guess…

          • …should have read
            Fasting Blood Glucose (fbg)

            & as far as i can tell
            serum=plasma minus the clotting factors

  20. Very busy and very behind in Q & A reading. Please forgive unintentional redundancies.

    H.pylori update: Stopped all of the enzymes and Lauricidin on Valentine’s Day and have had ZERO return of back pain, hives, heart palpitations and itchy eyes. Continue to mind my diet. Will bring back white rice in a couple weeks. But, I think Paul has suggested less rice than before because of the arsenic business. Will need to search out his comments.

    My current question: Something just shy of 20 years ago I inherited an Acme centrifugal juicer. Played for a while then discovered that celery juice helps with sleep. So, for the ensuing many years I made a veggie juice of cabbage, 3 stalks of celery, 1 apple, 3 leaves of dinosaur kale, and sometimes a bit of daikon or parsley or ginger. Drank this every night, thinking I was meeting my daily need for raw veggies. The best thing about this drink was that as long as I drank one glass, I slept through the night without difficulty. If I ever went off of it (travel, illness, etc) for more than a few days, it took three days back on the juice for the sleep benefit to kick in. I read in a juicing book that it is the potassium/sodium ratio in celery that causes the help with sleep.

    In 2011 was introduced to PHD, and the toxin concept, and stopped the raw juicing. My juicer is packed away at present. Lots of improvements to my wellbeing since going PHD completely, except that I no longer enjoy solid sleep. I awake between 2 and 3:30 every night, and usually cannot fall back asleep. I try going to bed very early, so that 3:30 can be my usual waking time, but then I wake between 11 and 12 midnight. I have come to look forward to those rare scratchy throat episodes so that I can have an excuse to take a night time cold and sleep aid.
    Can anyone help me with this?

    • Lana I could be wrong but think I remember Paul saying that arsenic was only a problem with rice grown in Louisiana.

    • Not saying you do, but have you checked to see whether you have obstructive sleep apnea? 90% of people who do don’t know it.

      • hi jack,
        how do you get a diagnosis for sleep apnea, would you need to go to one of those over-night sleep clinics?

        i also have no trouble falling asleep, but wake in the early hours & then tend to kinda half-sleep half-wake for the rest on the night (morning).

        I am actually seeing an ENT specialist next week to have a good examination of my nose and throat…so i will ask him about sleep apnea while i am there.


        • I wake up in the middle of the night too. 1 oz cheese + 10 grams carbs from potato or rice seems to help me sleep again.

        • Hi Darrin
          Sorry I missed your question till now. Please see my 12:59 answer to Lara below, which I think applies to your query as well. Sleep quality is important to health, and can be affected by many things. Briefly, we are unique in the animal kingdom in that evolution of our ability to speak has left us with a convoluted airway. Tiny differences in individual anatomy, aging, dentition and jaw structure, etc. can cause serious problems, not evident during our waking hours, once we become unconscious in sleep and our musculature goes into a completely relaxed state. I’d ask your doc for a home sleep study contraption as a first step.
          I also recommend this ENT http://doctorstevenpark.com/
          who specializes in sleep breathing disorders, and his book ‘Sleep, Interrupted’. There’s also a wealth of material on his website, he does podcasts and takes questions. (And he fixed my problems surgically, although there are many other options for dealing with sleep breathing issues which can be explored other than surgery).

    • Hi Lana,

      There’s nothing wrong with juicing vegetables that I know of, so as long as you don’t get so many Brassica vegetables that your thyroid is affected, it should be fine. Celery is fine. Tomatoes are a great source of potassium, if it is the potassium that improves sleep.

      I still support white rice eating, but you should avoid rice from the southern US, and brown rice. But potatoes are probably better overall, they are certainly more nutritious.

      Circadian rhythm strategies all help with sleep, those are discussed in chapter 42 of our new edition.

      Best, Paul

  21. Thanks Jack and Paul,

    Hmm…sleep apnea seems odd, since celery juice seems to eliminate the issue, and when my grandkids sleep over they never say anything about a snoring gran. 🙂 I’ll see.

    Paul, as I recall, it may have been that you wrote something about rethinking the brown rice syrup, not rice, itself. ?

    Back when I was reading your first book, I explored the bit about natural toxins and found an online chart of those in various veggies. The one in celery was psoralens. Supposedly, does not cook out. Also, cabbage was a good portion of my juice, thus, the worry about thyroid. Juicing allows consumption of greater amounts, and, thus, greater amounts of nutrients, as well as toxins. ??

    I do what I can with the circadian rhythm strategies. In fact, I found amber light bulbs and put them in the only lamps I use when I get home in the evenings. The computer program you suggest in the book doesn’t seem to do anything, and other odd things happened after I downloaded it. So, I’ve attached an amber transparency to the monitor. Don’t know if these are what you would suggest, but, I usually fall immediately asleep.

    Getting outside for “fun” early in the day is hardly possible. First, I live north of Seattle, and, second, I work in a public school with 1300 students. When the days are short, I arrive in the dark and leave in the dark. Occasionally, I can fake the need to go to my car for something, but it isn’t 10 minutes. I’ve been wondering about putting full-spectrum bulbs in my office lamps?

    Thanks again for the reply. The lack of sleep is causing me considerable difficulties.

    Hope the cookbook has suggestions for using bone marrow. Years ago I spread it on toast. Recently, I’ve sandwiched into my hash browns before flipping them in the pan. Very nice with my eggs.

    One more thing…my son tells me that he read that cooking egg yolks hard turns the fat into transfats. Ever hear that?

    • Hi Lana,

      Yes, it was the brown rice syrup we no longer favor. Between the rice bran proteins and arsenic, fructose in honey seems less objectionable; and there is tapioca syrup too.

      Yes, it’s true that consuming too many vegetables can be problematic, especially if they are goitrogenic. But one glass a day at bedtime isn’t likely to be a problem. Another possibility would be to cook the vegetables first — ie make a soup stock with them. That might help your sleep just as well and be much lower in toxicity.

      Any bright lights you can install at work would help.

      I don’t believe that simply cooking eggs is enough to change unsaturated fats into trans-fats. I believe that chickens have to get trans-fats in their feed in order to have them in their eggs.

    • Lana, again, not saying you have OSA. But when people have it they wake slightly without actually becoming conscious, over and over again. Then other factors can turn that into an outright wakeup once in a while. There are varying degrees of it, and not all include snoring. Don’t laugh it off unless you’re sure, because it’s very sneaky. I had no idea until it became really bad.

    • Lana – Try eating a handful of almonds or some other healthy snack about 15 minutes before you go to bed. I tend to wake at the 5-6 hour point, too. Very annoying. I noticed the nights I didn’t were nights I had a snack close to bedtime, now it’s my routine and I rarely wake at night.

      • i think there could be many reasons/factors for waking during the night.

        i have read that if eating before bed ‘fixes’ it, then the issue may relate to low blood sugar (hypoglycemia) during the night. possibly caused by low (empty?) liver glycogen.

        personally, eating before bed does not affect my sleep one way or the other

      • Thanks everyone. I would love to explore the OSA possibility, Jack. I have a student who is in a “sleep study,” and this sounds fascinating. Would love to participate in such a thing. Is that how OSA is found? I’ll be certain to mention it to my doc next time I’m there, which will be in a couple weeks. Thanks for the counsel.

        Tatertot, I’m SO glad you checked in. I’ve been looking for the plantain chips directions and have not found that post. I hope you wouldn’t mind sharing how to do it again. I have my green plantain waiting.

        Confession time. Since Christmas, my evenings have run so late my final meal is just before I head to bed. I’m thinking that hunger or low blood sugar is not the issue. I have wondered if it could be adrenal fatigue. Have a test kit but am trying for a day that I can be certain will be without surprises. Bought celery today and will juice three stalks and half an apple.

        The sleep thing started when I started into menopause, so I always figured it had to do with that. I have rarely suffered because for nearly all that time I have been drinking celery juice.

        Thanks again, everyone. Goodnight from the “best coast.” 🙂

        • Easy! Just slice them thin (experiment to find thickness you like) salt liberally and dry in oven set very low, like 120 if you can or air dry for a day or two until crisp.

          An easy way to peel green plantains: Cut in half crosswise and lengthwise, then just roll the meat out. You can’t peel them like a banana!

          Dry them, keep in a ziplock bag, don’t need refrigerated if thoroughly dried. I eat a few slices every morning and after dinner if I need something crunchy.

        • It can be even simpler than a sleep study in a lab (although the lab versions are the most thorough and are getting to be very comprehensive, including multiple brain wave tracks, etc.)
          If you have less time or want a simpler starting point, just tell your doc that you’re not sleeping well, don’t want to take meds, and from what you’ve read, think you might have sleep breathing problems (there’s a whole spectrum) or OSA, and want to do a take-home sleep study. (I wouldn’t even mention food and nutrition – at this point you just want him to approve this testing). It’s getting common now, and your insurance should pay for it. They’ll give you a device which usually consists of a fingertip pulse/blood oxymeter transducer, a couple of elastic bands for your stomach and chest with expansion/contraction transducers incorporated in them, and a nasal cannula to detect tinier amounts of breath. You just put these on, and activate the little black box computer connected to them, when you go to bed. Then deactivate it in the morning and take the whole shebang back to the lab to be analysed.
          It only takes one night, is comfortable and easy and will tell you a lot more about your sleeping body than you can detect yourself. Then you can either rule out sleep breathing problems or get them fixed.

        • Lana et al:
          Re: Waking at 3:00. Here’s a link to an MP3 of an online seminar broadcast today and detailing some sleep breathing issues that you may find interesting.

  22. Does anyone suffer from any sort anxiety related to the fat content in the PHD? I still am brainwashed that sat. fat is bad.. ‘too much’ is bad etc.. etc.. i’m worried about damaging my heart or getting high cholesterol.. i know, i know.. i am brainwashed but how can all our previous medical advise be wrong??

    also, any advice for gallbladder stones? i developed symptoms 3 years ago after my 3rd pregnancy. i cut back on fats as a result and symptoms slowly improved. a year ago i gave up gluten and i felt this almost ‘fixed’ me.. now after following the paleo diet and then the PHD… i feel a bit of heartburn and feel that it’s related to my gallbladder. i feel that adding coconut oil or not cutting back on fats might be causing some of the heartburn because of compromised digestion.

    • Hi Christine,

      There’s nothing wrong with adding more carbs if you’re nervous. Probably a lot of people who try to implement our diet initially undereat carbs because they don’t realize how large a volume of plants one has to eat to get 600 carb calories, and what a small amount of fat one needs to eat for it to provide 50% of calories.

      • Paul, have you noticed how many people, myself included have trouble understanding the volumes or weights or calories or energy calories or fist fulls to achieve the PHD ratios.
        what would work better for me would be picture’s like in your recipe section. i would love to see a picture of one day’s worth of food with something recognizalbe in the frame like a pack of playing cards to give the item’s scale.many of us cant believe that you can eat that much food in 2 or three meals. thks alfred

        • Good idea. Someone else did a post like that a few months ago, but I can’t seem to recall where. We’ll have to do one.

        • If I were to take this picture, I would assemble these raw foods:

          1 big steak (1 pound)

          2 big potatoes (1 pound)

          1/2 bell pepper, 1/2 carrot, 1/2 beet, 3 mushrooms, a couple brocolli florets (1 pound)

          Those 3 piles would be the bulk of the daily food, I’d have another pile with small amounts of nuts, dark chocolate, 4 eggs, and a couple pats of butter and a spoonful of olive oil.

          I would label this picture: PHD recommended maximum daily intake.

          Did I miss anything?

          • A little bowl of bone broth soup for a starter course.

            It’s funny to me that people have so many problems with this, because once you do it for a while, it’s really very natural to assemble a plate with the right proportions. In fact the old saw of 1/4 plate of protein, 1/4 plate of starch, 1/2 plate of veg works really well for eyeballing it as a start. I just add some kind of side of soup or yogurt or cheese and a piece of fruit that’s pretty good for me.

          • It’s funny to me that people have so many problems with this, because once you do it for a while, it’s really very natural to assemble a plate with the right proportions. In fact the old saw of 1/4 plate of protein, 1/4 plate of starch, 1/2 plate of veg works really well for eyeballing it as a start. I just add some kind of side of soup or yogurt or cheese and a piece of fruit that’s pretty good for me.

          • Tatertot,
            thks for the next best thing to a picture,i can see that clearly in front of me, however is it possible following those items as described, could the fat content be very high or low of the required 60% by calories. i seem to eat more fat than you have described, i cook with butter & coconut oil plus a teaspoon of c/oil in each of 4 cups of tea throughout the day, olive oil on potatoes twice a day [ the fat content of the meat is a mistery] thks alfred

          • Great word picture, TT. What a storm of questions Paul has fielded about portion sizes. With the first book, I got the scale and love, love, love it. I portion out my lunches for the week with it. Then the new book came out with references to so many “fist-sized” portions. A while back someone whose first language was not English wrote what seemed to be a sincere question wondering if the fist is “closed or open.” He also wondered if the rice was cooked or uncooked and wondered how one would keep the rice from falling out of one’s fist during the measuring process. I wrote to explain and his reply was appreciative.

            Lost in translation can be pretty funny. I still picture that gentleman scooping up his food in his fists. 🙂 If he’s reading this — thanks again for the lighter moment. I have a grumpy boss and need the chuckles.

            Happy week ahead. Wish I could go to Paleo Fx.

            Palm Sunday blessings.

          • Alfred – I think the fat portion is the biggest variable. If you are gaining weight, cut back on fats first. If you need to gain weight, include a bit more fat.

            You probably don’t want to eat in a way that has you shooting for a perfect macro-ratio every day, because it will be impossible to achieve. Get the meat/starch/veg proportions down, and the fat will follow naturally.

            Eat most of the fat attached to your meat, use butter and CO as needed, eat cheese and dairy as tolerated. Remember that nuts have a good bit of fat, too.

            I never add fat ‘just because’, but eat whatever fat is in my food or I use for cooking.

          • Elizabethe – Good catch on bone broth! We have been buying a whole organic chicken every Friday, put in a crockpot and cover with water on high for 6 hours, then get most of the meat off, add a bit of salt and vinegar to the bones and cook another 12-18 hours. We strain the broth, cool, skim the fat, and use the gelatinous broth for cooking rice, drinking straight, or other recipes needing water added. We rarely skip a week.

        • I think it’s worth it to get a digital scale and weigh the starches and make sure you get your 150 grams of carbs from rice and potatoes. Paul has even said somewhere people tend to underestimate the carbs if they’re not having flour.

          • Scales are awesome! I measure everything. Also there is a huge difference between getting “a pound” of a starch and getting 150 grams of starchy carbs between rice and potatoes.

  23. Around the Web: Palm Sunday Edition | Perfect Health Diet - pingback on March 24, 2013 at 2:49 pm
  24. Hi Paul and others,
    Regarding eating salmon weekly…
    I usually buy a frozen wild-caught Alaskan filet and pan-sear that most weeks. However, I’m concerned about the condition of the omega 3s after I cook it. Am I still getting benefit even though I cook the salmon all the way through, til it’s opaque in the center? Or is it necessary to only sear the outside and leave it a little fleshy in the middle?
    This has been a question on my mind for some time now because I would hate to be thinking I’m helping us get healthier if in fact I’m hurting us if those omega 3s are mostly all damaged. I do cook the fish at a lower temp and keep a constant eye on it, I just wish I could know if it’s better for us to eat salmon as sushi (not at home!) or even if smoked salmon is better? (Any thoughts, good or bad, about raw fish sushi and smoked fish?)
    Most of the time I pan-sear the salmon (with skin) in coconut oil, the basic directions from the (optometrist?) woman who posted the Bengali Fish Curry. It’s so delicious that way (lemon juice, salt, turmeric, coconut oil)!

    Anyway, just wondering about this…
    Thanks so much!

    • Hi KH,

      Yes, the omega-3s should be fine. If they are damaged it will only be on the surface of the fish. I think if you cook at a low temperature, there will be no problem at all.

      We ate sashimi for a while, but the Japanese market that we purchased from closed and we haven’t done it for a while. There is a risk of parasites, but the fish certainly tastes great. Smoked salmon is OK too.

      I think you’re doing great!

  25. Hi Darrin
    In answer to your more specific question – yes, absolutely. If a sleep study shows that you have a sleep breathing problem, an ENT who specializes in these disorders can determine where a lot of the problem lies by putting a scope down your nose and throat (not as bad as it sounds). It’s best to do it while you’re on your back, which is how Dr. Park does it. Scoping you while you’re sedated and asleep can be even better but isn’t always necessary for a doc who knows what to look for. Just having you breathe while scoped will create the venturi effect and show the areas which are vulnerable to collapse and restriction.

    • Thx for the get tested ‘on your back’ advice.
      did not think of that, but of course, makes complete sense.

      i will definitely request he does that, if he does not do as default.

      thx for your ENT rec, but i am in Australia.
      I found this guy, Dr Daniel Novakovic,
      seems to know his stuff & cover all the bases that you’ve mentioned.

      i can even get a copy of the ‘video’ on a usb stick to take home

      • Sounds good, but I think you should be able to find more of a sleep breathing specialist amongst ENTs there. Let me know how it goes.

        I have an apartment in Croatia and I’ll bet you a dollar this doc and his administrator are of that ethnic extraction.

        • “Dr Novakovic was born and raised in Sydney Australia. His parents are of Serbian/Croatian origin and he speaks conversational Croatian/Serbian.”

      • Sorry, did it again….not paying attention. I see now that they prominently list sleep disordered breathing as a specialty.
        Good thinking, and sorry for the multiple posts.

  26. Just one more point, if I may, while I’m harping on this OSA subject. There are lots of reasons for poor sleep, breathing restrictions being only one. There are all kinds of lifestyle, eating/drinking habit and metabolic problems which can disturb sleep.
    However it’s often not recognized that a sleep breathing problem doesn’t happily stay in its own little category. When sleep breathing is disturbed, even if it’s only caused by a comparatively simple to understand mechanical restriction, disruptions in brain function, blood oxygenation, hormonal balance, toxin removal, kidney function and a whole cascade of
    other complex metabolic effects can result from this simple first cause. We don’t spend a third of our lives at the activity of sleeping for no reason, and it has to fulfill its purpose if we’re to remain healthy.
    So, if one has a metabolic disorder – yes, of course it has to be corrected, but should that disorder be a downstream effect of a mechanical defect-induced sleep disturbance, the complex metabolic problem is unlikely to resolve without fixing that breathing issue.

  27. And NAC is anti-inflammatory; TLR4 inhibition will reduce reactions to LPS from gram-negative bacteria like e. coli


    naltrexone has this effect and is used for IBD; see my recent blog: http://hopefulgeranium.blogspot.co.nz/2013/03/our-first-song-for-today-is.html

  28. I’m watching this Everybody Loves Raymond episode called “No Fat” (S3/Ep10), where they try to have a low fat Thankgiving dinner with a tofu-shaped turkey, and hilarity ensues.

  29. Hi

    This may seem like an inane question but are the weights given for macronutrient rations for cooked or raw foods. I’m particularly interested in the protein weights.


    • Hi Loretta,

      We try to do uncooked weights, as they would appear in ingredient lists or you would use for shopping, but there have been a few instances when we looked up a cooked weight by mistake. Usually cooking reduces the weight by 20-25%, mostly from lost water, sometimes lost fat; which is not a huge change. In the end these amounts are just guidelines and you should adapt them according to your own appetite/desire.

  30. Hi Paul,

    I have a weird blood pressure phenomenon that doctors just seem to not want to discuss (I asume because they have no explanation). When i sit or stand, i have high blood pressure (diastolic in 90s) but when I lie down it is fine (diastolic in 70s). It is pretty much the opposite of postural hypotension (though I do very very occasionally get dizzy if I stand up too fast). Multiple health practitioners have observed it but they all just shrug and awkwardly laugh. One tested it multiple times and even tried to distract me while testing me seated because she thought it was psychological. I have a blood pressure monitor and it happens if I measure at home too. I worry because high blood pressure is a strong risk factor for some pretty bad stuff! Any ideas?

    I’ve been following a moderate carb (aprox 100g carb/daily) paleo diet for about a year and a half with lots of liver and yolks, I’m 23, female, have tracked blood glucose in the past and it has been fine. I’m a totally healthy weight but I definitely don’t do enough exercise (though trying to!)

    • Hi Sophie,

      That is weird. It seems unphysical, and I can’t find anything in Pubmed on that condition.

      I’m only guessing, but I wonder if it may be that the blood pressure in the arms is quite different from the pressure in the brain – ie your blood doesn’t reach the brain well when you are standing, maybe due to obstruction in a vessel to the brain? Do you have any evidence of vascular disease?

      Usually these postural changes in blood pressure are considered to be due to neurological dysfunction. Usually that is under-stimulation in response to standing, but in your case it would have to be over-stimulation.

      One thing I would check is whether it is the posture of the body that matters, or the posture of the head. If you are supine but your head is raised to vertical (ie neck bent 90 degrees), is the blood pressure high or low?

      Let me know what that test produces.

      • Hi Paul,

        I sent through my reply but it didn’t go through as a reply:

        No evidence of vascular disease as far as I know and I’ve never been a smoker and I’ve never been overweight. If I go to the snow, my hands and feet will get numb much more quickly than my partner’s but that’s only in extreme cold. Pre-paleo I bruised very easily and have always and still do bleed for a very long time if I get cut. After a gastroscopy a couple of months ago (Pre-paleo I had SEVERE reflux so was to check for cancer etc- all clear!), I was given a referral for a hematologist to investigate a possible bleeding disorder because I bled excessively during biopsies.
        I did the get you suggested- 3 times each position. Results:
        Sitting: 136/88, 136/93, 130/89
        Lying flat: 119/74, 130/78, 126/76
        Lying with neck bent up: 128/81, 126/84, 123/83
        Med history:
        ADHD (took Concerta for this years ago- now unmedicated)
        On the contraceptive pill (35ED)
        Celiac disease
        Mild acne
        Previous severe reflux (now only once a week at most and improving after trailing lessening of insoluble fiber, elimination of starches and nightshades for past 2 weeks)
        Pre-paleo: Joint pain, debilitating fatigue, underweight despite high calories
        Currently still some bloating.

    • @SophieE: This is just a shot in the dark, but in the book ‘Sitting Kills, Moving Heals’, Joan Vernikos mentions standing up a certain number of times a day to stabilize blood pressure.

  31. Hi Paul, I have a question about ghee. I make real ghee, caramelizing the milk solids as is traditional in India. Is there any oxidation I should be concerned over? Of course all milk solids are removed via triple cheesecloth filtration then sieve. Clarified butter doesn’t taste as good, but I would make that instead if there is concern over oxidizing fat. I’d love your advice here. Thanks so much!

  32. Hi paul,

    I have a question about having butter and mct oil in my coffee in the morning

    (is from the bulletproof exec blog, http://www.bulletproofexec.com/how-to-make-your-coffee-bulletproof-and-your-morning-too/)

    If I do this would I still get the benefits of intermittent fasting? or would the high amount of calories break the fast?

    Thanks in advance.

  33. I just got a diagnosis of Heberden’s nodules in my fingers, and “wear and tear” arthritis at the wrist base of my left thumb. I have also had trouble with body pain for seven years, so I am wondering is it going to be overall arthritis now?

    After about two years on the PHD diet, and I had positive results initially, I now appear to be chalking up more and more ailments. I’m very discouraged.

    After reading in a previous post Shou-Ching had also experienced similar symptoms in her hands and had luck with magnesium, D, vitamin c and K2 supplementation, I was encouraged. Thing is, I’ve been taking those supplements all along. Do I need to increase something?

    I’d appreciate any comments from people who have had success in a similar dilemma.

    • Hi Mary,

      When bone overgrows it may be due to a relative excess of vitamins D and K2 compared to vitamin A. So I would suggest eating more liver to increase your A. In addition to 1/3 lb beef or lamb liver per week, try some chicken, duck, or goose liver.

      Are you following our revised supplement advice — no multivitamin, not too much of other things?

      Best, Paul

      • I take only vitamin D (4000 IU), K2 (90 mg.), magnesium (400 mg.) and vitamin C (500 mg. to 1 gm.) I eat calves liver every week, as well as plenty of vegetables, many of which I grown in my garden, such as winter squash.

        We purchased a quarter grass fed beef. I got the bones and make bone broth a couple of times a month for delicious homemade soup.

        This has been the worst winter of my life, as I have been treated with antibiotics in January, February, and March for an ear infection, sinus infection, bronchitis and recently a urinary tract infection, only the third one I’ve every had in a life of 60 years!

        Presently, I’m on Diflucan due to all of that.

        I use yogurt, kefir, kombucha a kimchi on a regular basis.

        Needless to say, I’m tapped out. I am now considering a juice fast and NO supplements. It may be that PHD diet just does not work for me. I didn’t have the greatest health as a vegetarian either, but I never had a winter like this, not to mention the latest diagnosis.

        I see two doctors. My blood pressure is perfect, and my weight is perfect. My white blood count is a bit low. I am hypothyroid, but that is under control with Armour thyroid. I just seem to be sick and hurting all of the time! I turned to this diet in desperation. It is the complete opposite of how I was eating, so I thought maybe that would do it. I did feel better for a few months, then no longer.

        I’m thinking juice fast and no supplements. What have I got to lose at this point?

        • Hi Mary,

          In general it sounds like you are eating and supplementing healthfully. However, you may have specific infections which do well on a low-carb diet.

          Regarding your experience this winter, sometimes the antibiotics themselves can worsen things, especially if there is a fungal infection present at the same time (fungal infections invariably flare up whenever you take antibiotics, as it is probiotic bacteria which mainly keep them in check). All of the sites you mention (ear, sinus, urinary tract, mouth and throat) are common sites of fungal infections.

          Fungal infections do well on low-carb or ketogenic diets, so I would increase carbs some and decrease MCT oil / coconut oil if you take that. Also, you might shift from yeast-fermented foods like kefir and kombucha to bacterial ferments like yogurt. Try to eat the fermented vegetables at early stages of the ferment with a highly acidic brine.

          Hope this helps. If the scenario above is correct, then a juice fast could make matters worse by suppressing antifungal immunity. In other scenarios the juice fast might help, so you may need to experiment.

          Best, Paul

          • Hi Paul
            Would that be true also for water kefir? I’m trying to get some probiotics but can’t stand neither kefir or youghurt made from any milk due to giardia infections besides candida.
            I was wondering if sauerkraut would be ok although tried some and was not. Maybe it has stayed too long and developed other stuff in it besides probiotics.

          • David:

            Try making the fermented vegs


            They are simple to make. If you slice the vegs Into smaller pieces ( i use the thinnest slicing disk on my food processor) they will be ready sooner .

            Also raw cheese will be probiotic.but only hard style, no blue, no bloomy, such as Brie, no washed rind.

          • Paul,

            Do you think it is possible that a fungal infection could impact the way your body utilizes A, D and K and thus play a part in joint pain , bone spurs , etc?

  34. Hi Paul,

    Do you have any suggestion on how to prepare for an IVF cycle? My hormones will receive some injections and am a bit scared about the consequences of somehow ‘twisting’ my hormonal state to give me a chance to conceive a child. Any suggestion or readings you might have come across would be greatly appreciated!



    • Hi Jo,

      Not Paul but you might want to checkout healthybabycode.com/

    • Hi Jo,

      It’s important to be very well nourished. Mothers should build up nutrient stores for ~3 months prior to conception. That means eating a very nutrient dense diet including liver, egg yolks, seafood, bone and joint broth, magnesium, and so on — all the PHD recommendations, but extra liver and egg yolks due to the high choline needs of pregnancy, and maybe extra omega-3 from seafood. Also plenty of vitamin K2 from fermented foods eg aged cheese.

      That is all standard for any pregnancy. I wouldn’t do anything differently for an IVF cycle than for a regular pregnancy.

      Best, Paul

  35. Thank you, Paul! Eggs are really super for me, but my cholesterol went up to 260… (I eat at least 2 farmers market eggs a day). I know am still brainwashed by the ‘egg-cholesterol myth’, yet… is a total cholesterol of 260 (with 90 as good cholesterol) OK for me now?

  36. Paul,

    I have a 15-year history with depression: 3 separate episodes of major depression, each lasting 2-3 years. I took antidepressants sporadically and have been off of them for 5 years. They never made a dent. I have anxiety when I am depressed, also.

    I eat less than 10 g of carbohydrates per day, which keeps me levelled off nicely. I have tried to increase my carbohydrates experimentally, but even a small increase (20 g/day) leads to a very quick return of depression and anxiety, within 2 days.

    Why might such a small increase in carbohydrates cause such a severe and immediate negative response?

  37. Hello Paul
    I have really enjoyed your newest book. I would like to try your diet but I am not good at counting calories or trying to figure out grams of this or that. Is it possible to do it by eating a portion of protein and a portion of rice or potato/sweet potato, and some veggies and good fats at each meal? Low carb does not work for me; it makes me shakey and I am never satisfied. I suspect I have had a sluggish thyroid for a while and this was confirmed with a blood test – elevated thyroid antibodies (81 when should be under 35) and slightly elevated TSH level. Is this something your diet can help to heal? I gained weight when I added carbs back to my diet, although it greatly improved my HbAIc levels (my body needs the carbs). Thanks so much for everything you both are doing.

  38. I have a question regarding the TSH test…

    Has anyone got any views or thoughts on…
    Under what conditions & time of day you should get blood drawn for a TSH test.
    Because it could effect the result quite a bit.
    & make the difference from being inside lab range to outside lab range.

    ie. if you test in the afternoon in a non-fasted condition, your TSH would probably be at a fairly low point for the day.
    On the other hand if you tested in the morning on an empty stomach after an overnight 12-16hr fast, then your TSH would be a fairly high point for the day.
    It is feasible that you could test hypothyroid in the morning & euthyroid in the afternoon.

    So when would you test?
    I guess, it could come down to whether you want to be prescribed meds or not.

    thoughts anyone…

    a few ref links in next comment

    • a few refs,
      “The late morning non-fasting TSH tests declined in 97 of 100 subjects by an average of 26.39% when compared to early morning, fasting, TSH test results.
      This lead to reclassification of 6% of patients from presumptive subclinical hypothyroidism to “normal.” ”

      “The pattern was similar to that found in normal subjects, i.e., low TSH levels in the daytime and higher levels at night.
      In severely hypothyroid patients, no diurnal variation in serum TSH was observed.
      A practical consequence is that blood samples for TSH measurements in patients with moderately elevated TSH levels are best taken after 1100 h, when the low day levels are reached.”

      “Serum TSH, T3 and FT3 values in the early morning were significantly higher than during the daytime, but such change was not observed in serum T4 and FT4”

  39. Hello Paul,

    I have been reading the Perfect Health Diet and am finding it to be a very inspiring read. I recently completed a Whole 30 diet (a paleo diet for 30 days) and liked some of the results (fewer aches and pains, feeling of greater calm, more energy, less swelling) but did not get the dramatic results I’ve heard from others. I was seeking more information about the value of a paleo lifestyle and stumbled upon your book.

    I have been trying to identify an appropriate set of eating goals using the information in PHD but am finding this difficult to do. I’ll explain my difficulty. Using the online tool MyFitnessTracker I estimated that to maintain my current weight I would need to eat 1600 calories. To lose half a pound a week it suggests I eat 1410 calories per day. In reading PHD I estimated I could eat 20% carb, 20% protein and 60% fat. But when I calculated the calories for this, carbs and proteins make up less than 600 calories. I was also wanting to try a ketogenic version of this diet but can’t figure out the macronutrient proportions.

    I wonder if you would be able to shed some light on this and provide some clarity regarding macronutrient ratios for a 1400 daily calorie diet. Is 1400 simply too low?

    Thanks for your help and fabulous book!

    • Not Paul but have felt your confusion! I’m following PHD since Feb. 18th with great success, on the scale and inside and outside my body. Down 13 lbs and skin issues have come close to clearing up!! I eat 1200-1500 calories a day depending on my workout. I use MyFitnessPal to track my macros. Keep in mind that the 400 carb calories are safe starch based. I eat around 75 -100 grams of safe starch carbs daily, which equal 300-400 carb calories. I eat a few non starchy veggies which increase the total carb count when looking at the graph on MFP. listen to your body for what it is craving. My macros +/-5% are 50% fat, 30% carb and 20% protein. Some days I hit 15/35 protein and carb, some days 25/25, but my fat Macro almost always stays right at 50%. You will need to simply start PHD and play around with the macros to see what makes you feel better. Start listening to your body, it will help you figure out what you’re lacking. I know that sounds kind of hippie, but it is the truth! Best of luck to you!!

      P.S. Check out Jaybird’s weight loss success story on the website..he found alot of weight loss success when he was 50% carb on 1200 calories a day, one meal a day and coconut oil throughout the rest of the day.. I tried his way of weight loss for a few days and couldn’t function like that. Each person is different and you WILL find some balance. I stick to 2 meals and occasional snack within 6-8 hour eating window and I am all good!

      • Thanks for your reply to my post Libba. I was curious if your 30/20/50 ratio on 1200-1500 calories daily would be considered ketogenic too. I’m also wondering if you or anyone has some information regarding fasting through breakfast? Is breakfast not considered the “most important meal” of the day on this diet. Wouldn’t weight loss be more effective if dinner is removed or made earlier in the 8 hour eating window? Breakfast is definitely easy to skip and I have done this most of my life but I think it messes with my blood sugar because (at least while I was pregnant) failing to eat breakfast dropped my blood sugar so much it triggered migraines. On the Whole30 one was not advised to skip breakfast. In fact you were advised to eat within an hour of waking.

        I appreciate your comment that different things work for different people and will look up Jaybird’s success story for sure. Thanks again!

        • Hi KJK.

          I found that I couldn’t handle fasting through breakfast, whether for mental or physical reasons, I just have to eat first thing when I wake up. However, I find that I can skip dinner very easily. usually have a large breakfast at 7 or 8, a large lunch, sometimes as early as 11, and then, if I want it, a coffee or piece of fruit or chocolate at 3 or 4 and then nothing else for 16 hours. This pattern feels very natural for me. I’m hardly ever hungry for dinner.

        • I’ve never cared for breakfast and when I started paleo before I started PHD, I felt like I was stuffing myself to eat at breakfast. I eat 10-6 most days sometimes 12-6:30. KJK’s routine sounds good!

          I wouldn’t think I’m on a ketogenic diet. I was on a ketogenic diet years ago and I feel MUCH better doing what I’m doing currently.

          Here’s link to Jay’s story. Be sure to check out all the comments bc he and Paul answer additional questions that may prove helpful. Takes a bit of time but is definitely useful knowledge! http://perfecthealthdiet.com/2011/12/jay-wright’s-weight-loss-journey/

          • Meant elizabethe’s routine…oops!

          • Thanks Elizabethe and Libba for your helpful comments. I just read through Jay’s comments and story and found it very informative.

            It’s so interesting to see how both of you have just adapted things in a way that works for you. I love this flexibility in the diet! So it’s giving me a greater sense of freedom to experiment and confidence to go with what works for me. I also felt like I was stuffing myself during breakfast throughout, my Whole30 … But it also got me in the routine of having a substantial breakfast, rather than nothing. And in some ways it felt pretty good.

            I might just test out both of your approaches to the 8 hour feeding window and see what works better for me and is easier to sustain.

            One other thing I’m noticing as I have been recording my food intake for the past few days (I began the PHD three days ago) is I’m quite afraid of eating starches. I followed the specific carbohydrate diet some years ago which removes all complex starches but includes fructose from fruit sources and natural sweeteners like honey. I felt good on this and came to believe I had digestive issues with starches because I often felt light headed and fatigued after eating potato and rice. I think Paul discusses that this can happen in an unhealthy gut and references the SCD in his book.

            So I’m not sure what to do. Maybe include rice and potatoes sparingly until I feel comfortable? I have such a hard time seeing rice and potatoes as healthy. They appear to be “empty calorie” food to me. I also feel pretty awful after eating rice crackers, Maybe this points to some gut issue that requires some additional attention. I’m not sure.

            I would be happy to hear any thoughts or comments from others who can relate.

            Thanks again Elizabethe and Libba.

  40. Hi Paul,

    No evidence of vascular disease as far as I know and I’ve never been a smoker and I’ve never been overweight. If I go to the snow, my hands and feet will get numb much more quickly than my partner’s but that’s only in extreme cold. Pre-paleo I bruised very easily and have always and still do bleed for a very long time if I get cut. After a gastroscopy a couple of months ago (Pre-paleo I had SEVERE reflux so was to check for cancer etc- all clear!), I was given a referral for a hematologist to investigate a possible bleeding disorder because I bled excessively during biopsies.

    I did the get you suggested- 3 times each position. Results:
    Sitting: 136/88, 136/93, 130/89
    Lying flat: 119/74, 130/78, 126/76
    Lying with neck bent up: 128/81, 126/84, 123/83

    Med history:
    ADHD (took Concerta for this years ago- now unmedicated)
    On the contraceptive pill (35ED)
    Celiac disease
    Mild acne
    Previous severe reflux (now only once a week at most and improving after trailing lessening of insoluble fiber, elimination of starches and nightshades for past 2 weeks)
    Pre-paleo: Joint pain, debilitating fatigue, underweight despite high calories
    Currently still some bloating.

  41. Hi Paul and others,
    I just tested positive for H. Pylori and mycoplasma (the former with strong symptoms of bloating and occasional burning sensations, the latter none or minimal.) So unfortunately I have just begun antibiotics and acid blockers (not knowing what alternative may or may not be out there.)

    But I’m wondering what I can do to mitigate the destructive side of the antibiotics and acid blockers?

    • Hi Tim,

      I would take sublingual B12 occasionally while using the acid blockers, and take a probiotic regularly between antibiotics (in the longest dosing gap).
      My family were dosed with antibiotics last year and used probiotics (only intermittently) and had no side effects or after effects. One family member repeating this later without probiotics resulted in fungal infection. Simple and relatively low-dose L. reuterii plus L. rhamonusus, or Lactobacillus plus Bifidus, preperations seem adequate.

      • Thank you so much George, I will do this! I’m hoping I can eventually re-populate good gut bacteria and immune defenses so this sort of thing can’t take hold. Btw, I looked at your site a long time ago and it looked interesting at a glance; I need to check it out again and read more in depth some time.

  42. Hi George,
    Could you tell what brand/form of these probiotics were you using?

    • George Henderson

      I’m in N.Z. so brands are probably meaningless, but your pharmacist/health store should know which are reliable locally.
      I don’t think commercial probiotics repopulate gut flora, but they do protect what’s there, and help keep gut immunity normal.

  43. Brittany Andino

    HI Paul,
    I appreciate and all that Shou-Ching and you do and congratulations on your success! I have been following the PHD for two months now with the recommended supplements after being on a diet similar to this minus the starches and sugary in ground vegetables. I have experienced many improvements already including new hair growth, improved body temperature, higher and more consistent energy levels, regular bms, smoother skin, sounder sleep, etc. However, I am still struggling with painful menstrual cramps and painful ovulation. I have tried upping my magnesium during the cramps without any effect whatsoever. I have read tons of literature about this, but I do not know how I could improve the diet beyond what I am doing.( Carb-28%, protein-17%, fat 55%, very low in PUFA’s, all organic) Thanks for any light you may shed on this subject and Happy Easter!

    • Hi Brittany,

      Low potassium could be another cause. Try eating tomatoes and potato daily. Make sure you get adequate salt, and balance the magnesium with bone broth for calcium. Low-dose lithium might be another thing to try, cut the 5 mg tablets on our recommended supplements page in half with a razor blade to get 2.5 mg daily and test that.

      Best, Paul

  44. Hi Paul,

    Is there an easy way of consuming large amounts of coconut oil?

    • With a spoon.

      • I take it you live in a place with a generally high temperature?

        • I was only half kidding, in NY.
          When i get an afternoon coffee at work, with some half n half i put a spoon full (prob 2 tablespoons worth) in it, and drink it down that way. Can’t taste a thing.

          Wife cooks her eggs in it and puts it on muffins etc instead of butter.

    • Heat it to liquid and stir it into a glass of water. Not sure how experienced you are with coconut oil, but it’s best to start with maybe 1/2 tablespoon and work your way up from there. Starting off with too high of dosage will cause stomach discomfort and nausea.

  45. Happy Birthday Paul! 🙂

  46. Paul, I really appreciate your work. Thanks for everything.

    I have a couple of questions for you-

    1. Sweet and white potatoes have been my main source of carbs since I started eating a paleo diet about a year ago. Since reading your book, i’ve been eating some white rice and I feel like I am gaining weight and bloating every time I eat it. Is there an obvious reason for this feeling? Is it maybe because rice is not as satisfying as potatoes and one needs to eat more to feel as full?

    2. I’m 19 years old and have had acne for about 4 or 5 years. Eating paleo has helped a great deal, but it hasn’t resolved the issue totally. I’ve noticed recently that when I eat bananas, eggs, plantains, and dairy it worsens in a couple of days. I was thinking that maybe I have fructose malabsorption and can’t tolerate dairy. Is this something worth cutting out foods because of or will it probably just disappear as I grow older? Are there any reasons someone could still have acne after eating paleo for a year and eating something similar to your Perfect health Diet (more carbs than before) for close to 7 months?

    (and if it is your birthday, I hope it is a great one!)

  47. Paul, I am in ketosis possibly due to mitochondrial dysfunction (respiratory complex 1). I am eating quite a bit of carbs, gaining weight and have high BHBA (a sign of ketosis) on a metabolic panel. Do you have idea if my mitochondria are defaulting to fats for energy and if carb intake can influence this one way or another, and whether it would be best to tend toward low fat – high carb diet or a high fat diet and rely on the ketosis and stop the weight gain? I have pretty severe gut dysbiosis as well showing all predominant bacteria except bacteroides are very high. Beneficial bacteria are very high as well. I feel worse at least due to weight gain and GI issues with high and possibly mid range carbs. but I am not sure my mitochrondria will do well without them. Seems if I am gaining weight that mitos cannot use carbs well for fuel? Thank you for any insight you can offer!

  48. Paul, I am in ketosis possibly due to mitochondrial dysfunction (respiratory complex 1). I am eating quite a bit of carbs, gaining weight and have high BHBA (a sign of ketosis) on a metabolic panel. Do you have idea if my mitochondria are defaulting to fats for energy and if carb intake can influence this one way or another, and whether it would be best to tend toward low fat – high carb diet or a high fat diet and rely on the ketosis and stop the weight gain? I have pretty severe gut dysbiosis as well showing all predominant bacteria except bacteroides are very high. Beneficial bacteria are very high as well. I feel worse at least due to weight gain and GI issues with high and possibly mid range carbs. but I am not sure my mitochondria will do well without them. Seems if I am gaining weight that mitos cannot use carbs well for fuel? Thank you for any insight you can offer!

  49. Paul & co.,

    Is it recommended to use natural health treatments in tandem with conventional antibiotics & acid blockers, (which I’m taking for H pylori – with inflammation, possibly an ulcer)?

    That is, would garlic, glutathione, NAC, oregano, rosemary, ginger, etc. help the medicine do its thing, or would they conflict?

  50. I’m just really curious to know if you have an opinion on GMO crops.

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