Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. Paul, alos…
    they have said she has a leaky gut…
    would this explain the prolapse? how long and what should we do to heal her insides so that she can eat all of these Nourishing Foods?

    Hi Cassie,

    Candida and other fungi release MMPs (matrix metalloproteinases) which are enzymes that break down tissue barriers and destroy tissue integrity. This is why they commonly cause diverticulosis – a deformed shape of the colon, but also have been known to form diverticulosis of the urinary tract, bladder, esophagus, and other tissues. I would expect they can cause the prolapse too, especially if she has constipation/diarrhea which stresses the tissue.

  2. Thanks for all the replies, Paul, I know I can get pretty annoying. I went to my doctor today and took over his office for a good half hour tryin to convince him to prescribe me doxy for possibly diagnosing a brain infection. He responded, saying a brain infection is encephalitis, and if I had it I would be in the hospital ( adding on there is no mild case of it and a .00001% chance of having a chlamydia pneumoniae infection). Instead he suggested drinking sugary drinks when times got tough and prescribed a low dose of Ritalin. I don’t really know where to go from here…

    Hi Sam,

    Well, don’t take the sugar or the Ritalin. Your doctor is not up on the literature, an unfortunately common occurrence. They just don’t know how to diagnose chronic infections, only acute ones.

    You can ask for a referral to an infectious disease specialist, they might be more knowledgeable and self-confident. Or consider obtaining antibiotics by indirect methods, eg for other sorts of evidence of infection that would give your doctor cover before a review panel.

  3. Your book and website and the help you give people are all wonderful. We have been on the PHD for three months and would really appreciate some advice.

    Ten months ago my husband was diagnosed with severe bileaflet mitral valve regurgitation, severe left atrial dilatation and atrial fibrillation. He is a fit, lean, asymptomatic 67 year old who has been physically active all his life, never smoked, very rarely consumed alcohol, has never taken any medication and was relying on fish oils for blood thinning until we read your book.

    We were vegetarian for over thirty years, discovered Weston Price and started eating meat 6 years ago (because of my ill-health) and have consumed an awful lot of Nordic Naturals CLO over the past six years.

    Wild salmon is only available canned in Australia but it tastes reasonable, whereas the farmed salmon is tasteless and we have been told by the best fish shop proprietor here that it is rubbish. We can get ‘fresh’ sardines for eight months of the year but they are very strong and smelly while tinned King Oscar’s are OK. We are now consuming 1 lb of canned fish a week and I feel that the fragile oils must surely be degraded by the canning process and that we are probably worse off than when we were taking fish oil. Previously, when taking CLO, we ate delicious fresh snapper once a week.

    The cardiologist says my husband is at risk of stroke and heart attack and should take warfarin. I have just read Ray Peat on aspirin and fatty fish and I am wondering if I should try to persuade him to at least take low dose aspirin.

    My husband’s mitral valve must be repaired or replaced when he develops symptoms or when his heart starts to enlarge, which the cardiologist says is likely to happen within two years. We have been told that he would have been born with granulated, thickened tissue in the valve and that it is probably genetic, though no-one in his family has been known to have had any type of heart problem. He had pneumonia when he was a big, muscular 18 year old rower and two years later, after a public health programme chest x-ray (routine in Australia in the fifties and early sixties), he was hospitalised with suspected TB. After a few weeks in a TB ward they realised it was just a scar on his lung. He managed to completely avoid contact with doctors for the next fifty years until a mole check ten months ago when a doctor took his blood pressure (120 over 60) and noticed his pulse.

    The only health professionals he has seen in the last fifty years are dentists – he has had dozens of tooth abscesses, often ignored for months or years. Despite our vegetarian diet (with a huge emphasis on whole grains, salads and fruit) he always had amazing energy until the last few years when he became very tired. His energy has returned since giving up grains and he has many signs of good health – energy, high body temperature, warm feet. He didn’t like taking fish oil as it made him burp a lot. Can you please tell me what you would do regarding fish/fish oil/aspirin if you were in his position?

    We are following all your recommendations except synthetic vitamin D, K2 and multi-vitamin/minerals. My husband is about to have his vitamin D level tested but he has taken the same amount of CLO as me and mine was 91nmol/L in 2009. We get plenty of sunshine and I am not sure how much K2 we should be taking considering vitamin D levels.

    The multi-vitamin/minerals available in Australia have the ratios all wrong and many of the ingredients are the cheaper, harmful ones. We are now taking magnesium, selenium, iodine, chromium and vitamin C. A hair analysis done about five years ago showed that I had a very high copper level and my copper/zinc ratio was badly out, which is apparently common here due to high copper levels in the soil. We now eat 1/4 lb of liver twice a week and I wonder if I should be concerned about the copper in liver and in multi/minerals.

    Sorry this is so long. I would be very grateful for your advice.

    Hi Francesca,

    If cod liver oil works better for you than fish, then go for it. Just don’t overdo it.

    I don’t want to be a doctor to you but personally I would never take warfarin. Just the opposite, I would take vitamin K2 in high doses. But start with a low dose and increase gradually. K2 is extremely important. The more A and D you get, the more you need it.

    Vitamin D is also important. If you don’t get sun, and if your CLO had vitamin A, then an A : D/K2 imbalance could be causing your husband’s heart problems. Make sure his vitamin D is optimal.

    Micronutrients, especially the minerals and vitamin C, are also important.

    Usually these conditions are caused by the interaction of vascular infections with malnutrition, and his history of infections would support that being the case here as well. Most of the pneumonia-causing pathogens can establish chronic vascular infections as well.

    I would be cautious about aspirin. Even the “baby” dose I think is too much on a chronic basis. You could cut a baby aspirin in quarters if you feel it will help. It can help, but it can also impair immunity and damage the digestive tract, so it is a bit of a wild card.

    Copper excess can be a problem. But zinc supplements should prevent copper toxicity problems, manganese might be indicated as well. If you are convinced copper intake is high, then you can switch from beef/lamb liver to chicken/pork liver which are much lower in copper.

    Best, Paul

  4. Paul, in your book, when you say to eat 250 protein calories a day, am I correct in assuming it would be approx. 62.5g. protein (250/4)? And 300 calories of safe starches would be 75g. carbs (300/4)?


    Hi Kim,

    Yes, your math is right, but those are rather minimal intakes. Remember carb+protein should be at least 600 calories / 150 g per day, so if you go that low in protein you need higher carb consumption. Also remember that these “gram” measurements are not the weight of the food, which is much larger, since food has a lot of water and other non-caloric ingredients.

  5. Paulette Bradstreet

    I will continue to read the site but please remove my email address from receiving email follow up comments.
    Thank you.

    Hi Paulette,

    I’ve removed you from the email list, but for the benefit of others, you can remove yourself as well. I believe there is a link on the page allowing you to adjust your subscriptions.

  6. Can anyone point me in the direction of a discussion on NAC here at PHD?

    Hi Michelle,

    I don’t believe there’s been a detailed discussion. It’s helpful for immunity and as a glutathione precursor; it’s most likely to be beneficial during infections and/or on a low protein diet. For a healthy person if protein intake is adequate there’s no need for it.

  7. Hi Paul
    I’m actually trying to help my mother out. She has very brittle nails – they are becoming increasingly painful. She also has really low body temperatures with her feet and hands are always cold, and lots of skin dryness. She started fish oil and that helped for several months with the nails but is no longer helping. I’ve had her take Vit K also but that has not helped either. Any thoughts or suggestions as to what may be going on? I’d really appreciate it.


    Hi Radhika,

    First, is she eating our diet and following our supplement program? That will relieve a lot of potential problems.

    Other things that might help the nails: Epsom salts for sulfur – either externally as a bath or orally 1 tsp per day in water. Salt. Biotin. Vitamin C. Multimineral supplement.

    Other things for hypothyroidism: Has her thyroid status been checked by a doctor? She might benefit from thyroid hormone. In the meantime, she can start the hypothyroidism nutrients discussed in our book.

  8. thank you for responding paul!
    We tried raw dairy, but she reacted to it..mucous..rash, swollen tonsils.
    Thats why we started GAPS because in the intro i guess is all about healing the gut and balacing flora. I thought the fruits were furthering the candida. She was always craving..i mean fits if she couldnt have grapes..bananas..high sugar fruits. She is always a wreck..emotionally and now developmentally its starting to show..when befor antibiotics she was always “ahead”.

    What do you suggest as a daily diet for her? I will try goats mik again(at the moment she is sick again..so i will wait to not further mucous)

    What do die off symptoms look like?

    What carbs? What fruits?

    Also have the prescription for nystatin, but was advised that it only temporarily fixes candida and fungus..then it comes back when you finish using it.
    I guess my biggist question is..how do you heal the gut so she can eat eggs,,dairy?? It just seems like even with all the supplements..that she doesnt absorb them. we had her on brainchild nutritionals minerals and vitamins, and other supplements but nothing seems to take.

    good bless you for taking the time to respond to all of us
    You must have wonderful karma!!!
    It really is hard when your childs health is at risk.

    Also the regular Gaps is not so bad if you add some carbs like potatoe and rice?

    a million thanks to you

    Hi Cassie,

    Yes, potatoes and rice will greatly improve the GAPS diet.

    Her reaction to the milk might be die-off effects. Swelling lymph nodes and mucus are consistent with that. When you give her more glucose, suddenly she can make mucus and mount an immune attack against the fungus. I would use detox aids:
    1. Fat soluble: cholestyramine, bentonite clay, or charcoal.
    2. Water soluble: salt, water.
    Die-off symptoms may include fatigue, sleepiness after meals, difficulty sleeping at night, swollen feet, liver and kidney stress, acne. The common element is strong immune activity, and fatigue is a universal symptom.

    I believe if you use these along with the milk + rice/potatoes + PHD/GAPS diet, heavy on the raw milk, she might have a few tough days but should start doing much better within a week.

    I think I wouldn’t worry that much about food allergies at this point. You need to get the right macronutrient mix and deal with the fungal infection so that her gut can heal. Allergies may go away once that occurs. She may not even have allergies at all, it might be die-off symptoms.

  9. Hi Paul
    Thanks for the quick reply. Unfortunately, she has high cholesterol and is predominantly vegetarian. She added eggs to her diet based on my recommendations and her cholesterol went up so the doctor told her to stop the eggs. Same with fat. Her weight has been increasing and she is very concerned about adding more fat to her diet. I’m not sure what to do about this. She does take Vit c and a multivitamin daily. I will add epsom salts and biotin to her supplement regimen. I also read online that colorless iodine applied to nails can be helpful. Do you know anything abut that?

    I don’t think she has ever been tested for hypothyroidism. I will look at your book and get her started on those supplements.

    Hi Radhika,

    After the first week I would reduce the Epsom salts to 1/4 tsp a day, which should be a good maintenance dose. That’s about 225 mg magnesium per day and a bit more sulfur.

    Let me know how things go.

    Best, Paul

  10. Paul- Quick addition to my reply above. My mother has really good energy levels. She works out regularly and keeps herself going the whole day.

  11. Dear Paul, I posted on Oct. 9, but have not received a reply. I know you are extremely busy, but would appreciate a reply, if possible. Additionally, I eat no grains except for occasional rice, Mostly meat, fish, and vegetables. Some milk, usually whole, un-homogenized. I keep a garden that is usually fairly productive. Take vitamins and supplements such as Vit. D3, krill oil, Vit. K, Selenium, CoQ10, Acetyl L-Carnitine. Thank you. Bud T.

    Hi Bud,

    I replied in your previous comment.

    Best, Paul

  12. awesome..
    just to clarify though..She was on raw milk..it was when we took her off that her tonsils finally went down.I mean, up until we removed gluten and casein, she was an emotional diaster most of the time.
    doesnt dairy even raw, aggravate candida? feeds on the yeast ? i thought?

    Hi Cassiel,

    I don’t think of milk as an especially pro-fungal food. I would guess maybe she has a dairy allergy.

  13. Hi Paul,
    I agree with Cassie when she says that you must have great karma and God Bless You. I am so grateful for your thoughts on the cause of my husband’s mitral valve problem and on warfarin and aspirin. We have taken a stance against them for ten months but we needed the opinion of someone with more scientific knowledge than ourselves, someone we trust and admire, in order to continue going against the pressure from the cardiologist.

    I imagine that my husband would have to start with a very low dose of K2 because he has such an increased risk of a clot forming in his enlarged left atrium. What dose would you suggest and how gradually should it be adjusted? We don’t yet know his vitamin D level.

    As you have said that minerals are important I will put more effort into finding a decent multi-mineral – in Australia it’s more difficult than you would think.

    Thank you so much. I don’t know when you find time to sleep.

    Hi Francesca,

    I would agree that vitamin K2 should be scaled up, but it doesn’t need to be scaled as slowly as iodine.

    He does have the option of taking warfarin with K2. I would avoid that as much as possible, but warfarin with K2 is much less harmful than warfarin without K2 supplementation.

    Vitamin K2 also promotes the production of anti-clotting factors, so its effect on clotting probability is not clear. But it is helpful for tissue health, so that is why he should be taking it.

    I hope you can find a good mineral supplement, especially one with selenium, magnesium, zinc, copper, and manganese.

    Best, Paul

  14. Hi Paul,

    My 42 year old daughter has six month old twins (first babies) who are breastfed but topped up with formula after each feed. They are very obviously wanting solids, they love mashed ripe banana but don’t like egg yolk after several attempts. One baby developed a rash around the mouth both times. My advice has been not to give sweet potato because orange vegetables can cause problems for an immature liver, not to give potato this early because of possible future nightshade allergy, not to give rice cereal this early as it will displace the more nutritious milk, not to give apples or pears because of the fructose and not to give avocado because it has too much omega 6. Not much help.

    I was thinking of bone broth – is six months too early for meat blended in bone broth? If not what sort of meat would be best and how fatty? What would an ideal diet be for infants aged six to twelve months? At what age could they start drinking raw milk? At what age could they start eating sweet potato and potato? Is rice cereal lacking in nutrients?

    We can’t find any reliable information and wouldn’t believe anyone else anyway, so once again we would be very grateful for your help to get these babies off to the best start possible.

    Hi Francesca,

    I answered most of this below: http://perfecthealthdiet.com/?page_id=4228#comment-38404. Sorry I’ve been slow to answer.

    I think organ meats and bone marrow are best because they are more nutritious and fatty, babies don’t need much protein. I would also include rice (well cooked, or even as rice syrup). Look for nutrition from other sources, but a baby still needs plenty of carbs and there aren’t many toxin-free sources of carb calories, so rice is an excellent staple.

  15. Paul,

    What do you think the affect of the sun has on infection status purely from a disinfectant standpoint?

    I remember while backpacking a cool trick to help purify water was to put it in a clear container and let it sit in the sun for a few hours.

    There are even commercial products to disinfect water using artificial uv-light. ex: http://www.steripen.com/


    Hi Chris,

    I certainly wouldn’t count on sunlight disinfecting my water. Giardia seems to thrive fine in shallow mountain streams with high sun exposure. UV doesn’t penetrate that far into water, so water level would have to be very shallow for this method to have a chance.

  16. Hi Paul,

    I am trying to follow your diet. I just started two weeks ago. As I am taking anti-microbials for Lyme disease and Babesia, I want to tend toward a ketogenic diet.

    I have taken an occasional tablespoon or more of coconut oil in the past, sometimes twice a day, to aid effectiveness of Mepron. I had no problems. Since reading your book I have tried to increase my intake to 6-10 tablespoons a day.

    It seems to cause immediate diarrhea – very unusual for me – especially on an empty stomach. I take probiotics regularly. Any suggestions for digesting the coconut oil better, as in keeping it from going right through me?


    Hi Ed,

    While a ketogenic diet should help against the Lyme, it may be harmful against the Babesia, which is a protozoa and can metabolize ketones. So you’ll have to be careful about this.

    In any case I wouldn’t take so much coconut oil. Since we wrote the book, most people have reported that they get the benefits of ketogenic dieting, and have fewer side effects, on smaller doses. Especially with a protozoal infection, I would try to find the minimal effective dose of coconut oil.

    Also, many people find MCT oil more tolerable than coconut oil. Coconut oil has a mix of MCTs, 12-carbon fats which can go both ways (to the liver with MCTs and to chylomicrons with longer fats), and long chain fats. This seems to be harder to handle than MCTs exclusively.

    So: I would try 3 tbsp MCT oil a day, and keep an eye out for whether the ketogenic diet is counter-productive in Babesia. You may be the first person to report trying a ketogenic diet with Babesiosis, so I’d love to hear how things progress for you.

    Best, Paul

  17. Hi, I have a problem with excessive nocturia, related to protein intake. I don’t remember having this problem when I first started paleo in June of 2010. It seems to have started or gotten significantly worse last spring. I recently had some blood work and a urinalysis done for this problem through my GP and they said everything was normal. I have not gotten a copy of the results yet.

    My Experimentation has determined this:
    If I eat as much protein as I want whenever I want, I wake up 4-5-6 times/night to pee.
    If I eat as much protein as I want but stop all protein consumption after 3, I wake up twice.
    If I eat moderate protein and stop consumption after 3, I wake up once.
    If I eat moderate protein and stop all carb and protein consumption after 3, I wake up once.

    I taper water intake after 3 and try to intake hardly any after 7. This is a problem for me because I don’t feel as good on high carb and don’t do well with nuts or dairy. Extremely limited food selection.

    24 years old, 6’1 165. Lift 2x/week, surf, and walk for exercise. Stress-free job. Supplement with probiotics. Try to eat moderate carb paleo (sweet potato post workout) and feel great on it generally. Don’t feel as good with more carbs than that. Don’t feel good lately because I’ve been binging on nuts and raisins to compensate for not being able to eat protein after 3. Spent 2 months in Central America last winter.

    Thanks for any input, not being able to sleep is no fun!

  18. Sheep Counteress

    Hi Kyle,

    I have similar concerns and look forward to Paul’s response to your questions.

    I was wondering whether you’ve tracked your thirst relative to protein intake? I find that protein without much carbohydrates leads to extreme thirst. Like you, I don’t tolerate nuts/dairy well, so with an already-moderate carb intake, am loath to increase the starch (never mind fruit) even more. So that leads to more water intake, which leads to more going to the bathroom?

    Do you find that increasing carb can mitigate the need to drink more water? I am thirsty enough to drink 4L of water every day, +/-2 cups depending on how much carb I have/have not consumed. I think lower carb also leads to poorer sleep, which leads to more easily waking and thus recognizing the need to go to the bathroom….

  19. I’ve had trouble finding someone else with this problem!

    Unfortunately, I haven’t tracked my thirst at all, I just try to drink a full glass in the morning then drink when thirsty. I would say that I do not experience excess thirst from excess protein intake as I stay below 100 ounces of water in a day.

    I haven’t quantified any affects of carbs on sleep or thirst. I used to think carbs pre-bed would stop me from peeing as much during the night, but then I did an experiment and found that stopping protein and carb consumption after 3, had the same results as stopping protein consumption after 3. It was only a 5 day experiment however.

  20. not a question.
    just thought this study may be of interest to some.
    “The physiology and pathophysiology of human breath-hold diving”

    This bit was interesting:

    Carbohydrate depletion.
    Prolonged periods of physical work deplete the carbohydrate stores (glycogen) in the body, which forces the body to compensate by increasing the rate of lipid (fat) metabolism. When the human body burns fat to produce energy, it uses 8% more oxygen than when metabolizing carbohydrates. Also, 30% less CO2 is produced by fat metabolism. Thus a breath-hold hold diver who has depleted the glycogen stores will become hypoxic faster, and, making the situation worse, the CO2 driven stimulus to breathe will be delayed. A dive that could safely be performed in a rested and well-fed state may be dangerous after a long day of exertion from diving or land-based activities. Carbohydrate intake has been shown to reduce breath-hold durations, due to more rapid CO2 generation (because of a higher RQ) in subjects who had fasted for 18 h, suggesting that that the risk could be reduced by proper carbohydrate intake and that breath-hold diving on an empty stomach may be dangerous.

    (shout out to cliff on paleohacks for the link)

    Hi Darrin,

    Yes, it is interesting. Thanks!

  21. hi am an exercise physiologist and loved the book, especially your comments on fish oil tablets and rancidity. just wondering what your thoughts were on fish oil that has been fermented (as the article in wise traditions) where the pacific islander s fermented the oil inside shark stomachs – does this render the omega 3 fatty acids stable so as to avoid rancidity? i assume the process enhances other nutrients as well?

    Hi James,

    Fermenting is going to increase lipid peroxidation, because bacteria release various toxins and compounds that promote oxidation. Fermenting inside shark stomach may minimize the exposure to atmospheric oxygen which would accelerate lipid oxidation, but I’m not aware that it would stop bacterial oxidation. However, I must admit I haven’t investigated this. Fermentation does generate more nutrients, but you can get those by eating other fermented foods, such as fermented vegetables or dairy, that don’t have the same lipid peroxidation risk. So my recommendation would be to stick with fresh, unfermented cod liver oil.

  22. I just read a really interesting piece on Robb Wolf’s site, http://robbwolf.com/2011/11/07/the-reverse-challenge-a-personal-experiment/

    My question is in regards to the feelings described in this self experiment. The man says when going on his SAD “trip”, he experiences the sensation that his stomach is full but his mind keeps telling him to eat/not satisfied. I was wondering if this is the benefit of a good diet, i.e. Synchronizing satiety between your head and your mind. It seems that I experience this problem a lot, always having my stomach full but my mind keeps telling me that it’s not satisfied and needs more. It also seems that by the time i eat enough to fulfill the signals my mind is sending me, I begin to experience the uncomfortable, and often debilitating, effects of ingesting massive amounts of food (no doubt overeating).

    I was just wondering if there is any explanation for this lack of synchrony and if adopting a correct diet is the only way to fix it….and maybe how long it will take to fix…

    Sincerely, Samy

    Hi Samy,

    Unfortunately these kinds of appetite regulation abnormalities are not well understood. Usually they result from the presence of inflammation or cytokines in the brain, or in important regulatory organs like the pancreas or liver. The cytokines do not have to originate in the brain in order to enter it and cause trouble.

    That leaves a lot of scope for many possible causes, including an array of infections.

    I wouldn’t dare hazard a guess as to the cause, especially as I lack knowledge of your personal history. But I do believe it is curable.

    Best, Paul

  23. Hi Paul,

    I know you must be flooded with questions and I greatly appreciate you taking the time to reply no matter how busy you are. Visiting your blog has been part of my daily activities and I am learning so much and trying to finish reading all the posts including the comments.

    This is my 6th week on PHD and last week I increased my carb intake to 30% from 20% the first 4 weeks. I am trying to get pregnant and thought on experimenting on higher carb intake using of course PHD. Last week however, both my ears were itching and my doctor told me that there’s inflammation on the outer ear canal and she calls it “ear eczema or swimmer’s ear” probably caused too much by swimming in the pool. She prescribed an ear drop which I’ve been using for 3 days now and suggested I do not eat sugar, dairy and starch for at least 3 weeks. I haven’t dropped the starch because based on what I’ve learned so far from your blog is that starvation of carbohydrates increase the risk of fungal infection and a moderate carb intake is helpful to fight fungal infection – which I think is the cause of my ear eczema. I’ve only been using rice syrup since I started PHD but only about 1 tablespoon once a week but this week I haven’t had any sweets including the 100 g of blueberries that I eat with 1 tblsp of sour cream everyday. I would love to hear what advice you can give. Thanks in advance Paul. Btw, I had one of my friends read my PHD book and she’s been converted. 🙂 She’s a vegan and have started on PHD yesterday. I am encouraged! I am getting her a copy of PHD as I wanted mine back. I have lots of notes almost on every page and I keep referring back to it. 🙂 Your book is indeed on my list for christmas giveaways. So grateful I found your website and book. Best regards to you and Shou-Ching.

    Hi Els,

    I do think the ear eczema is probably fungal in origin. Usually the ear is not the only location, and there may well be a gut problem. Be sure to monitor your tongue to see if you develop oral thrush.

    Some good things to do include eating green leafy vegetables (for nitrates), extra virgin olive oil (polyphenols which are antifungal), balsamic vinegar, antifungal herbs like oregano, thyme, and turmeric, sulfur-rich plants like garlic and onion. Good supplements include glutathione/NAC, and lots of salt and water. You can mix a teaspoon of sea salt with hot water in a mug, swish it around in your mouth and if it doesn’t taste too bad, swallow it. The salt will help provide chloride for stomach acid production and immune function, also clearance of toxins.

    Let me know how it goes.

  24. Paul, I appreciate your response. Since my original post, I have had a test for Chlamydia Pneumoniae. The results came back today. The IgM was <1:10 in a reference range of <1:10 titer. The IgG was 1:256 in a reference range of <1:15 titer. The RNP to whom I went is not familiar with either this test or this infection, and cannot tell what the test results mean. Can you advise me on this? Yes, I eat as strict a PHD/Paleo diet as I can with some supplements as I indicated in my previous post. I am trying your regimen, I just feel washed out all the time. Thank you, Bud T.

    Hi Bud,

    That IgG titer indicates that you have been infected with C pn, but there has probably not been strong recent activity in the blood (indicated by a titer of 1:512 or higher). There is some discussion in this paper: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC105350/. However, C pn is predominantly an intracellular pathogen and it can do most of its damage without causing high antibody titers.

    You might want to go to the site http://cpnhelp.org and tell your story there. There are a lot of people with C pn infections there who may be able to help you interpret your symptoms.

    As is usually the case, the antibody test is inconclusive. You have a C pn infection, but we don’t know that that’s what’s causing your symptoms. It may be worth an experimental antibiotic protocol, to see if you improve.

    Best, Paul

  25. HI Paul,

    I was wondering if you knew why it is rather difficult (i.e. feeling dull, no energy, just plain louse) transitioning to eating 400-600 carb calories a day (from a former of at roughly 1000). The way you explain glucose utilization to be roughly 400-600 calories worth of glucose makes sense, so why am I having difficulty not taking in those extra carbs (that are only being turned into fat anyway!).

    Hi John,

    Well, how long have you been at it? There are several possibilities. One is that wheat is rich in opioid peptides, and when you cease stimulating the opioid receptors you can feel lousy for a while until the body adapts.

    Another, as you mention, is a need to adapt to metabolization of fats.

    If you eat extra coconut oil, promoting ketone generation, that may help.

    A third possibility is that you lack some micronutrients needed for your new diet. You might take extra biotin (needed for gluconeogenesis) and other vitamins and minerals for a while.

    Usually if you’re well-nourished this should sort itself out fairly quickly. Let me know how it goes.

    Best, Paul

  26. Sorry to add on another question, but I’ve noticed extreme difficulty doing intermittent fasts on a moderate carb diet (i.e. anything over your 400-600carb calories). And meanwhile following your carb parameters i’m feeling dull and out of energy. Should i just force myself through the difficulty and become “fat adapted” (i assume that’s what i’m lacking), or should i just remain eating a higher starch diet. Thanks again for any input!

    Hi John,

    Try taking coconut oil and vegetables during your fast; maybe some protein, eg a boiled egg. It’s possible you have difficulty maintaining blood glucose levels through a long fast. You can give yourself time to heal as you adapt to the new diet. If eating more carbs and eating 3 meals a day helps you, then do that for a while. The most important steps are eliminating toxins and being well nourished.

    Best, Paul

  27. Hi Paul,

    I read in your reply to Els’ comment that you suggest eating balsamic vinegar as part of an anti-fungal diet. I thought we fungally types were to avoid yeast-fermented foods like vinegars, alcohol, kombucha, kefir, etc. What am I missing in my reasoning that makes balsamic vinegar ok, or even helpful, on an anti-fungal diet? And would this missing info make a little bit of alcohol ok too? (I’ve got box tickets to an SEC football game this weekend and it’s hard to pass up the open bar, especially when I’m already passing up the grain-, sugar- and n6-laden catered fare. A girl’s gotta live!)

    I’d love to be able to include balsamic in my diet again, so am quite excited to hear your reply.

    Hi SGW,

    I should have just said vinegar instead of balsamic vinegar. It’s the acetic acid I wanted to promote, not fermentation. I do believe in avoiding yeast-fermented and moldy foods if you have a fungal infection.

    Is most commercial balsamic vinegar fermented? I wasn’t aware of that.

    Alcohol is problematic with fungal overgrowth in the gut, as Candida and other fungi usually metabolize it into toxins. However, I do moderate drinking (1 glass of wine a day) myself.

    Best, Paul

  28. Hi Paul,

    When replying to SGW could you also address eating mushrooms on an anti fungal diet…okay or not and if okay, why.

    Many thanks.

    Hi Ellen,

    Mushrooms are fine. Although they are fungi, they are very different. The main concern is gene exchange and suppression of immunity or elevation of toxin levels so that the addition of dietary fungi promotes growth of the existing fungal infection. I don’t think mushrooms do that.

  29. Paul, Thank you for your prompt response. I have a friend who recently had C pn, and who successfully treated his case with MMS [chlorine dioxide]in 6 to 8 weeks. It was he who first suggested that I might have C pn. He works in the medical field, and is quite knowledgeable, but I have a lot of mis-givings about this. On the other hand, I do not look forward to months of antibiotic therapy. Can you advise me on this approach? Thank you, Bud T.

    Hi Bud,

    I haven’t heard of MMS / chlorine dioxide therapy and I don’t see anything in Pubmed on clinical use of chlorine dioxide.

    It’s a fragile, reactive way to deliver chlorine and I’m not convinced that’s necessary or desirable. Simple table salt can deliver large amounts of chlorine safely. That’s how I would go. Mix salt and hot water, swish it in your mouth for a while, and swallow if it doesn’t taste too bad.

    Best, Paul

  30. Hello Paul,

    I suspect that most people that follow your blog also follow the blogs of Danny Roddy, Ray Peat, Chris Kresser, et. al. Or maybe it is just me? Either way I have some questions regarding some massive differences of opinion. First, what is your take on Danny Roddy and Ray Peat’s love of fructose? It is my understanding that fructose in moderate quantities is not bad, but also not necessarily good. However, Danny links to a few studies on his blog that suggest the opposite (ex: http://ajpgi.physiology.org/content/253/3/G390.short) and he claims some great advances with what seem like huge quantities of fructose. Is fructose in fact simply okay in moderation, but not really useful? Is it only damaging in the presence of PUFA’s?

    Second, my partner Leah, who I have spoken of previously and who is currently undergoing treatment for cancer, was recently recommended by a doctor at Mayo to take flax for the lignan content. Obviously I hesitate due to the incredible level of Omega-3 present in flax. Thoughts on the cost/benefit of flax for a breast cancer patient?

    Lastly, you recommend moderate drinking as long as it takes place in the absence of PUFA’s.. but what are your thoughts on alcohol’s ability to increase the circulating estrogen levels? I wonder if this correlation would be applicable for a person with a healthy diet (one that is free of toxins)?

    Thank you for your thoughts!


    Hi Lindsay,

    There do seem to be some situations where fructose might have benefits, but the benefits tend to be small and rare, and the harms are much better attested. In the paper you cite, they have to poison the liver to see the benefit. Most people aren’t doing that so there’s no reason to infer that fructose is going to be beneficial in normal people.

    Fructose does deliver energy specifically to the liver, and in some circumstances this may be desirable. But since too much energy is pathogenic, especially for metabolic disorders, these tend to be special cases rather than a general rule.

    Fructose is much more damaging in the presence of PUFAs. So it’s good to eat fruit apart from PUFAs.

    Flax is OK, and I think that’s a solid recommendation. The ALA form of omega-3s isn’t as fragile as the more unsaturated longer forms. As long as the flax is fresh then it should be fine.

    Re alcohol, unless you have an estrogen-dependent cancer or some other hormonal pathology I wouldn’t worry about it, I would just restrict drinking to moderate amounts (~1 glass per day). If you do have one of those conditions I would consult the doctor for advice, and search Pubmed for evidence about alcohol in that specific pathology.

  31. Thanks for your reply re Vit K2 while awaiting mitral valve surgery. Taking into consideration that the effect on clotting probability is not clear and that the person is at risk of stroke and refusing all blood thinners, would you take 100mcg per day as a starting dose?

    Would also appreciate your thoughts on solid foods suitable for babies of six months. Egg yolk caused a rash around the mouth, mashed banana sometimes causes constipation. Does sweet potato cause problems for an immature liver? How early should potato (being a nightshade) be given? Are apple, pear and avocado best avoided until over 12 months due to fructose levels? Is rice cereal just a filler with a low nutrient level? Would you recommend raw liver baby pate? If so, would that be just a few spoonfuls a week? Could they have meat cooked in bone broth at this age and if so would blended meat from lamb shanks be suitable or would ground grass fed beef 30% fat be OK? Dieticians recommend blended vegetables such as green beans, broccoli, etc. Are these best avoided until over 12 months? Would babies be better off eating just meat and milk for the first twelve months? How should butter, coconut oil, cream and yoghurt be given?

    Hi Francesca,

    Yes, 100 mcg is a good starting dose. I would do that for a few weeks to a month and then consider increasing the dose.

    Babies at 6 months have a still-immature immune system so you want to avoid allergenic foods, toxin-rich foods, and fiber-rich foods. Fermented dairy is OK, but I would avoid too many vegetables. Interesting that the banana causes constipation; not sure what that means. I would avoid the apple and pear because of fructose, but I think avocado should be fine. I think sweet potato should be good but some people are sensitive to it (we did a post on that, What’s the Trouble With Sweet Potatoes?); potatoes should be excellent, try mashing in some sour cream or coconut milk; rice cereal is good; babies need a lot of carbs and it’s much easier to provide it with some rice. Liver pate sounds great! Bone broth is excellent and much needed, especially if you cooked bones with lots of white material from the joints. Meat is OK but not too much, babies need a fairly low-protein diet; you could get protein exclusively from organ meats and not even include any muscle meats. I do think the vegetables are more warranted after 12 months. Milk and yogurt should be good, but you have to watch for sensitivities; their nutrient content is superb but they can be difficult to digest. You can make smoothies/custards/puddings with berries and rice flour or rice syrup to help get some of those into the diet.

    I’d be curious to hear your experiences. We need to research baby food in more detail, so don’t take what I say here as gospel.

    Best, Paul

  32. Hi Paul,

    Thank you so much for the prompt response. My doctor asked me if I exhibit other symptoms of fungal infections such as oral thrush and many others but I don’t. It’s only the ear eczema and I am keeping an eye on the list of symptoms that she told me might occur.

    I don’t eat as much green leafy vegetables, just a mixed fresh salad leaves (I eat organic veg. like a mixture of baby spinach, French and Italian leaf mix, purple cabbage, endive, arugula, red onions, etc.) once a day, but will definitely start to include more green leafy vegetables. As for extra virgin olive oil and balsamic vinegar so will have to start using both as well, but I do use coconut oil and coconut wine vinegar and of course will include more of the antifungal herbs you mentioned. Haven’t supplemented on glutathione/NAC but have just ordered them from Amazon (using the link on your recommended supplements). And I’ve just now started swishing around my mouth the salt and water mixture and drinking it is not as bad as I thought. I hardly use salt in my cooking and do not eat salty foods either.

    Btw, I continue to shed off some more fat even after I’ve increased my carb intake to 30% last week. When I started the PHD 6 weeks ago, I weighed 128 lbs and now 122.4 lbs. I just hope I keep losing the last few fat I wanted to shed off. Btw, I only weigh myself once a week at the same day and time without fail and I also use a Digital Body Fat Caliper to measure my body fat. So yes, I am definitely losing some body fat and no muscle loss! That’s only after doing PHD for 6 weeks without changing my usual cardio & weight training regimen. My trainer was very impressed when she weighed me last week. I told her about PHD because she’s one of those people who believes in eating 5-6 small meals a day. 🙂 I’ve done that for years but I am definitely doing better by practising IF 16/8 and eating only 2-3 meals a day. I am definitely seeing positive results since I started the PHD! The elimination of wheat, sugar and cheese which I used to eat a lot everyday has done great wonders in my body. I love cheese and it’s hard to give it up! 🙂 Once I get into my ideal weight then I’d occasionally eat a little bit of cheese and include rice syrup as well.

    I greatly appreciate your help. Will certainly follow your advice . . . will keep you posted on what’s going on. Thank you very much Paul.

    Hi Els,

    I’m glad you’re doing well! We eat cheese ourselves, so you might try re-introducing that and see if you do OK on it. It’s really moldy cheeses I would be wary of.

    Have you tried topical anti-fungals on the ear? I tried about 4, two worked and two didn’t. Some species are resistant to some antifungals, but if they work then it confirms its fungal, and you have a treatment. If it keeps recurring then it’s likely you have a systemic infection of some kind, not just a skin infection.

    Best, Paul

  33. Paul,
    Just found Paleo about 2 months ago and have devoured everything I can read and hear on it, especially your site. Thank you so much for your contributions to this area. Your material seems to be grounded in science, which is refreshing.

    I just ordered your book using the Amazon site-link. Came up with a ship date of 2-3 weeks. Are the books back-ordered? If they are, that must mean the book is taking off!

    Hi Scott,

    The book is doing well, but that’s not the reason for the delay. Amazon has them in stock, but is slow-selling them, I believe to punish me for not having a Kindle version. I expect that it will return to being in stock once I make the Kindle version available.

    Best, Paul

  34. Hi Paul, I have some good news. My step-dad, who has Parkinson’s, has been following the PHD diet + supplements and doing intense cardio 5x weekly (advice from his neurologist) for the past 6+ months has not declined so far. I don’t think there’s been improvement in the tremors, but the lack of decline is already really great 🙂 My own problems (gastroparesis & IBS) are improving slowly but remain chaotic. It appears I may have been misdiagnosed and that endometriosis may be the cause at least of the IBS symptoms. I will post an update after I have all the test results. All the best, Claire

    Hi Claire,

    Thank you for sharing the update, that is good news! Has your step-dad gone ketogenic, or is he just on the regular diet?

    I am glad you are getting a better diagnosis. Endometriosis can be painful, you have my sympathy. I look forward to your update.

    Best, Paul

  35. Hi Paul,

    I was just wondering when you suggest trying a ketogenic diet as a diagnostic tool against bacterial infection, how long do you need to be on the diet in order to get reasonable feedback. I know that I feel rather crummy on the first couple of days and tend to stop because of it. Does that mean there’s no bacterial infection or that I just haven’t been at it long enough?

    Hi Stan,

    The ketogenic diet is a therapy for bacterial infections but a diagnostic tool for fungal or protozoal infections. In general it should make you feel better or the same if you have a bacterial infection, but worse if you have a fungal or protozoal infection. Of course, you can have both types of infection at the same time – co-infections are very common.

    I usually recommend following our regular diet and supplement program for a few months, to get fully adapted to a high-fat diet, then trying the ketogenic diet. See John’s questions (http://perfecthealthdiet.com/?page_id=4228#comment-38281) for an example of the difficulty interpreting adaptation issues.

    In all of these experiments, reproducibility is key. Before coming to any conclusions, it’s good to repeat an experiment a few times. Go off ketosis by adding starches and cutting MCT oil; go on it again by cutting starches and adding MCT oil.

    Then the question is: what are the specific effects you see? Are they signs of immune activity or infection?

    So as a method of diagnosis, there is some art involved. Hope this helps!

    Best, Paul

  36. Hi PAul,
    I read that during the initial days of ketosis the brain is unable to use ketones. Is there any truth to that?

    Not that I’m aware of.

  37. Sorry I meant to be more specific. During the adaptation period the peripheral tissues become IR in order to preserve glucose for the brain. It is this 3 week( or so) period where the brain increases its ability to use ketones. So the initial period of change in symptoms ( in regards to a brain infection) seems to be of little diagnostic value…. Meaning you need over 3 weeks to be able to use any symptom amelioration or aggrevation as diagnostic criteria, right?

    Ah, I see. Well, I think if you have a brain infection the brain will benefit immediately from ketones. If neurons are being starved of glucose by an infection, they will be seeking energy substrates wherever they can find them, and brain usage of ketones will increase more rapidly than in starvation/fasting.

    However, ketogenic dieting is also diagnostic for peripheral fungal or protozoal infections.

    But I would agree that it may need some time, and multiple times coming off and on the ketogenic diet, to get a solid idea of its effects.

  38. Honestly I gave strict paleo and then lbs a go for months and my mood was depressed, had low energy, Low libido, etc, becoming desperate I switched the safe starched with brown rice syrup and coconut sugar and immediately in the short term I feel better… Mood is so important and I don’t think trading ketosis for depression is a good move…

    Hi Darius,

    Agreed. In your case, if brown rice syrup doesn’t cause the trouble then it’s clear the problem is in your gut — only when gut microbes are fed (eg via starches) do you have trouble. That gives you something to work on.

    Best, Paul

  39. Sorry, lbs is phd, this blog format really stinks on my android.

  40. Just a wee note on Francesca’s baby food query re liver pate. It is important to note that baby foods should not have added salt. Babies have suffered kidney failure from eating mashed adult foods AFTER salt to an adult’s taste was added. Commercial liver pates, from what I can tell, do have added salt, so any pate should be home prepared, leaving out the salt.

    Thank you Scotlyn!

  41. Like Bud above, I posted a question (Oct 12) and an update (Oct 19), but no reply. I have a couple other questions now, along with some new evidence. Do you think glucose deficiency can cause/exacerbate histamine intolerance? I started Vit C a month ago and tolerated high dose for several weeks, 15 grams a day. Also added Vit D (4000 IU) and iodine (500 mcg). Am now at about maybe 4.5-6 grams of Vit C a day, and using bowel tolerance as the guide to amount. Right after starting Vit D, I found evidence of worms and am waiting for the results from Metametrix. Also, I have had some improvements: the hunger has greatly reduced, and the histamine reactions are definitely less severe. Two days ago, I decided to try intermittent fasting, because I now felt I could actually skip a meal but I could not sleep that night at all. Will repeat sometime to confirm. Also, last night I ate a potato, and within an hour started getting a headache, which is the usual reaction for me for high histamine foods. Sometimes I can tolerate potatoes, sometimes not. I ate some whipped cream with rice syrup and the headache went away. I had similar success with honey last summer when I was not eating rice or milk, but I cannot tolerate honey anymore, or apples or maple sugar (too much morning grogginess, another weird symptom). Up until today I was eating buckwheat cereal every morning, but I think I will replace it with rice. Buckwheat is often lauded for reducing blood sugar, and I wonder if it is making things worse for me. Also, many people on GAPS yahoo group have histamine problems. How long does it take to get over a glucose deficiency? I also think there is some underlying infection and/or parasite, but will wait for test results to confirm. Thanks for all the information you provide, it has helped me tremendously.

    Hi Naomi,

    I’m glad you’re doing better. I will finish answering all the old questions next weekend. Sorry about the delay, I got overwhelmed.

    Intestinal infections often produce the intolerances you’ve experienced — fructose and fiber-rich starches, resulting in allergy-like immune reactions. It looks like what you’re doing is working, and the Metametrix tests will tell us more. When you have an infection that consumes glucose, fasting can be quite difficult. I would avoid fasting until you have made further progress, and stick to glucose sources that give you the least trouble, like rice and rice syrup.

    Best, Paul

  42. Hi Paul,

    Thank you for the thoughtful reply regarding diet for Lyme borreliosis and babesia. Interestingly, in reviewing comments, I saw Els question about ear eczema, a problem I have had my entire adult life but especially bad now.

    I associate my migraines with babesia. I associate fatigue and body ache with borreliosis. The extreme ear dryness and itch? I do not know.

    Given that the ear problem could be fungal and the babesia migraines are my most debilitating symptom, I intend to stay away from the ketogenic diet for now. If I understand correctly, ketones encourage both Babesia and fungals. Is there anywhere I can read more about which pathogens are encouraged/discouraged by ketogenic diets?

    Hi Ed,

    I believe that eukaryotic pathogens benefit from ketosis, while ketosis is therapeutic for bacterial infections. Viruses are hard to generalize about, but ketosis is probably beneficial for most viral infections.

  43. Hi PauI,

    Re cheese, I only eat Brie, Gruyere, Cheddar, Mozarella, Camembert de Normandie, Manchego, Feta & Parmigiano Reggiano. I don’t like Stilton or any of the more moldy cheeses. Been avoiding cheese for the last 6 weeks though because when during the winter months I usually get dandruff when I eat cheese everyday. I’ve only had Parmesan once 3 weeks ago when I made a Brazilian cheese bread using your recipe. That was excellent by the way. I love it! Will try to include cheese back into my diet once again.

    No, I haven’t tried any topical anti-fungals on the ear. This is the first time I’ve had ear eczema and my doctor only prescribed a drop. It seems to be working as my ears are not as itchy as it was last week. I will be seeing my DR next week and will find out more if I need to continue with the drops or change the medication. At which time I will tell her I wanna try a topical cream. Btw, this week I’ve also tried the Epsom salt bath for the first time and love it! 🙂 Will be doing it regularly from now on. Thanks so much for all your help. Keep up the good works. Best regards to you and Shou-Ching.

    Hi Els,

    Best to you! You might try experimenting with the cheeses individually, since as Ellen notes below some of those cheeses may be mold ripened.

    The Brazilian cheese balls were Mario’s recipe. They are delicious indeed!

    Glad you like the Epsom salt! If you’re low in magnesium it can really help mood; and the sulfate is valuable for wound healing.

  44. Hi Paul,

    The information re baby solids was tremendously helpful, thank you. Just one more question – you recommend custards/smoothies/puddings, would it be OK to use raw cow’s milk in these for 6 month old babies who are breastfed but topped up with formula at every feed? At what age do you think the formula could be dropped and raw milk be given?

    Also, I heard Chris Kresser, on a podcast, say that orange vegetables are too hard on a baby’s immature liver. Not sure about that.

    Hi Scotlyn, thanks for your comment about salt for babies, it made me do some research. Weston Price say that salt is often left out of commercial baby food, in the mistaken belief that salt should be avoided. They say that baby foods should be salted with unrefined sea salt “to activate the formation of glial cells in the brain, the cells that make connections and help us to think faster.” The baby liver pate will definitely be home prepared. Commercial food will never pass the twins lips.

    Hi Francesca,

    I would almost suggest raw cow, goat, or sheep milk as a substitute for formula, but they are high in protein and should be topped up with a fat (egg yolks if tolerated are good, beef fat or other animal fats, coconut oil are possibilities) and a carb (rice syrup may be a good choice). They could be mixed with banana or potato or some such thing too.

    I think raw milk should be topped up with fat and carbs at any age. As for when to transition off formula, I think sometime after 6 months (if breastfed) or a bit longer (if on formula) is a reasonable time to start introducing solid foods, and the milk is probably more easily tolerated than solid foods.

    But again, this is not an area of expertise for me, so please don’t take what I say here as reliable info. It’s just an educated guess.

  45. Els,

    Camembert and brie are also mold ripened. So any soft type cheeses with a “bloomy” rind would be best avoided along with the blues:

    “When starter cultures are introduced, mold spores can also be added to produce rinds and molds. This technique is often referred to as seeding the starter culture. The two most common types of mold spores added to cheese are Penicillium candidum and Penicillium roqueforti.

    Bloomy-rind cheeses have white, green, floral, and/or grey rinds that look a bit like velvet. Some cheeses like Bries and Camemberts have pure white rinds, while others, like Selles-sur-Cher and Valencay have bloomy rinds grown over layers of vegetable ash. Either way, the bloomy rind is the result of a mold spore called Penicillium candidum. In France, Penicillium candidum occurs naturally in aging caves, and these spores are harvested and reproduced for cheese makers around the world. The spores arrive in freeze-dried form and are added directly to the milk along with starter cultures, coloring agents, or both. Nothing happens to the curd right away, but while the cheese is aging it literally blooms with a soft, velvety white mold.

    Not all blue cheese is called Roquefort. The name “Roquefort” is controlled by the Appellation D’Origine Controllee of France.

    In France, some bloomy-rind cheeses are not inoculated with Penicillium candidum during the starter-culture phase. Instead, the cheeses are aged in rooms or caves that have been used for this purpose for decades, some for hundreds of years. Only one kind of cheese is aged in each cave or room, as the mold is part of the room and forms on the cheese without being introduced in any other way. To some, the results are indistinguishable from cheeses inoculated during the starter-culture phase.

    The mold you see in blue cheese is grown by Penicillium roqueforti spores, which come in many varieties. Almost all blue cheeses are made with a strain of this spore. Again, these spores occur naturally in the caves of Roquefort, France, and are harvested, reproduced, and distributed worldwide in freeze-dried form. Penicillium roqueforti works differently than Penicillium candidum. Instead of growing a bloomy white rind on the outside of the cheese, it grows a bluish green mold inside the cheese.”


    Hi Ellen,

    Thank you! It was a pleasure to meet Harvey at Wise Traditions, and to receive your book. I hope to meet you next year.

    Best, Paul

  46. Paul said:

    “Is most commercial balsamic vinegar fermented? I wasn’t aware of that.”

    Okay, I’m confused, isn’t ALL vinegar fermented?

    From http://www.versatilevinegar.org/faqs.html

    The dictionary defines vinegar as “sour wine” or “a sour liquid obtained by acetic fermentation of dilute alcoholic liquids and used as a condiment or preservative.”
    How is Vinegar Made?

    Vinegar is made by two distinct biological processes, both the result of the action of harmless microorganisms (yeast and “Acetobacter”) that turn sugars (carbohydrates) into acetic acid. Many of our favorite foods involve some type of bacteria in their production – from cheese and yogurt to wine, pickles and chocolate. The first process is called alcoholic fermentation and occurs when yeasts change natural sugars to alcohol under controlled conditions. In the second process, a group of bacteria (called “Acetobacter”) converts the alcohol portion to acid. This is the acetic, or acid fermentation, that forms vinegar. Proper bacteria cultures are important; timing is important; and fermentation should be carefully controlled.

    Hi Ellen,

    I was thinking of “fermented foods” more as foods that still have live microbiota in them … not just acids manufactured by bacteria, but which when sold commercially don’t include the live microbes.

    But you’re right, “fermented food” admits of two interpretations.

  47. Hi Paul,

    I’m sorry to keep beating a dead horse, but unfortunately I can’t seem to understand something. Everywhere I search online I find that glucose utilization in the brain remains constant for up to nearly 48 hours after complete starvation (i.e. 100% glucose consumption). So i can’t understand how intermittently flirting with ketosis (i.e. PHD diet) will help diagnose or even cure a bacterial brain infection. I understand in a previous response you said that neurons would seek out any substrate they can when bacteria is withholding their precious glucose fuel, but i can’t seem to find any sources that support that.

    Hi Sam,

    If the ketones are there, neurons will metabolize them and that will displace some glucose. So the issue is more one of ketone production, which may ramp up slowly during fasting for many people, but which can be induced during a short fast if you take MCT oil.

    There is a paucity of sources specifically testing these ideas, but I believe this is how it works. If you eat enough MCT oil, you’ll generate ketones, and the response can be diagnostic.

  48. Hi Francesca,
    I’m absolutely certain your babies will be fed with the greatest of care, and importantly, with carefully considered knowledge.

    I only put in my comment because I think commercial pates are easy and convenient to reach for, and nicely pre-mashed, but because of their salt content are probably not at all suitable for babies. So, it didn’t seem like a good idea to leave the suggestion that pate is good infant food to stand without some qualification.

    It is true that babies do need some salt in their diets, too – but their kidneys cannot process more than around 0.4g sodium (1g salt) per day – much, much less than an adult would take. The necessary amounts are certainly already present in breastmilk, and probably in formula, so not needed in foods until after weaning, and even then, only in tiny amounts.

    Where parents have occasionally and unwittingly hurt their babies, has been in feeding mashed adult foods, particularly commercial foods such as wheatabix, for example, or mashed food from their own plates, without realising that the salt content may be way beyond what the baby’s kidneys can handle. This will first damage the kidneys, then the brain, and can lead to death. It pays to know this and take precautions.

    Thanks, Scotlyn. It’s good to know how much salt is appropriate for babies!

  49. > Thank you for sharing the update, that is good news! Has your step-dad gone ketogenic, or is he just on the regular diet?

    He makes sure he has at least 200g of carbs daily, plus some coconut oil. I think the aim is not to go totally ketogenic and he’s trying to up his carbs more with rice crackers.

  50. I have a question for you about a good friend of mine. She has terrible pain (contractions) – like giving birth (and she had a baby 2yrs ago) – every month from ovulation to menstruation. She’s had this since she was 19 and its been better and worse through the years. She has been hospitalized numerous times and sometimes even morphine isn’t enough. Alas the doctors can’t find anything wrong – only slight traces of endometriosis – but more recent laproscopic surgeries have shown no further traces.

    I am not sure if you have heard of something like this or what she could possibly do, but the next step is to get a hysterectomy and I just wanted to check with you if you thought an infection may be the underlying cause. I was thinking she could maybe do a trial of antibiotics before getting the hysterectomy just in case because the latter is so final. Or maybe a hysterectomy isn’t so bad?

    Here’s a little more info to give a picture. Probably not enough, but if you have any ideas of where I can look further please let me know. She was treated for an intestinal parasite 5 years ago and it did help with intestinal problems but not her menstrual cycle. She has tried lots of anti-candida type diets, but she found she does better with carbs. She eats a varied and healthy diet, avoids all sugar – although I do think she eats some gluten (homemade sourdough bread). She has tried numerous hormonal therapies – and did improve somewhat with the typical birth control pill (estrogen+progesterone)- but the pain was more spread out during the month. She was put into temporary menopause (don’t know the name of the medicine), but this did relieve her pain. She now uses the mirena IUD (progesterone only) and the monthly pains have come back with a vengeance.

    Hi claire,

    It sounds like she is in pain whenever progesterone is high. That would fit with the pain from ovulation to menstruation, the birth control pill giving lessened but continuous pain, “temporary menopause” relieving pain, and a progesterone IUD increasing pain.

    But I have no idea what would cause that.

    Here’s what I found on a brief perusal of the literature:

    Progesterone can cause increased sensitivity to pain in women: http://www.ncbi.nlm.nih.gov/pubmed/20816879. It could be she has some low-level continuous pain from endometriosis and the progesterone amplifies that. This effect involves opioid pathways, I would suggest that she give up foods with opioid activity (wheat and dairy). She might try low-dose naltrexone (since morphine causes higher pain sensitivity, the LDN may reduce it … she might take the LDN in the daytime, not before bed, so that she can better judge its effect on pain … LDN blocks opioid receptors for ~6 hours then raises opioid levels the other ~18).

    Progesterone may be able to amplify pain originating in the colon from IBS: http://www.ncbi.nlm.nih.gov/pubmed/21167789. (“Elevated levels of progesterone and/or estradiol on the amygdala heightened the responsiveness to colorectal distension”).

    A possible link to IBS is supported by the finding that IBS symptoms tend to get worse between ovulation and menstruation: http://www.ncbi.nlm.nih.gov/pubmed/19406367

    Pain issues may be worse with elevated estradiol levels: http://www.ncbi.nlm.nih.gov/pubmed/20194038.

    Some studies link progesterone levels to pain: http://www.ncbi.nlm.nih.gov/pubmed/19393713. (“Within-phase analyses revealed that pain ratings were positively correlated with estradiol and progesterone during the luteal phase. Moreover, increases in estradiol and progesterone across the menstrual cycle were positively correlated with increases in pain. These findings suggest that variations in gonadal hormones during the menstrual cycle influence the experience of pain in healthy women.”)

    Here’s an interesting paper: http://www.ncbi.nlm.nih.gov/pubmed/18614289. The ability of progesterone to cause pain hypersensitivity is related to glycine and GABA receptors. A neurosteroid that positively modulates GABA receptors but downregulates glycine receptors reduced pain. I don’t know if this neurosteroid is available as a treatment. But she might try ketogenic dieting, which increases GABA levels. She might also experiment with eating bone broth or supplementing glycine – glycine and GABA are both associated with pain relief. Read this: http://www.painonline.com/2006/07/the-odd-glycine-receptor/

    She could have fibromyalgia, which is probably infectious in origin, and its pain level may be increased by progesterone: http://www.ncbi.nlm.nih.gov/pubmed/17074627

    Progesterone increases pain through effects in the brain and these may be blocked with the drug finasteride: http://www.ncbi.nlm.nih.gov/pubmed/12467128

    Well, that’s what I was able to find. I certainly think there are opportunities to experiment and see if any of these things may help.

    Best, Paul

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