1. alfred June 24, 2013 at 11:42 pm

   hi Paul,i think my wife [a T2 insulin dependant diabetic would like to continue with everyday 16 hr fasting] however she may have adrenal fatigue how do we test for this. i read your note on having a small early meal of egg and tomato. would this be enough or are there other things we can do

   Reply
2. Michael June 26, 2013 at 8:03 am

   Hi Paul,

   Do you have any idea why someone might get depressed/heightened level of emotiona sentiment/increased reactiveness when eating a moderate or high carb diet?

   I have been integrating more carbs recently after eating relatively low carb for a year or so and have been experiencing increased emotion, and not necessarily in apositive sense… Is there anything physioclogical that could be going on?

   Thanks for your time

   Reply
   • elizabethe June 26, 2013 at 9:40 am

     Hi Michael,

     In case Paul doesn’t get back to you soon, he talked a little about depression and bacterial infections in a recent podcast, I think it was the one at Not Just Paleo.

     http://notjustpaleo.com/?p=1914

     Essentially there seems to be a link between depression and some pathogens and if you eat more carbs it could be feeding the bacteria more. I guess the solution would be to be tested for infections to see if that’s the case with you.

     The other thing I can think of is some kind of blood sugar reactivity, a spike followed by crash. That’s just a thought. If it’s that kind of thing you might want to check out tatertot’s whole discussion on potatoes and blood sugar. If you search this Q and A thread, you can find it, and he talked about it in the comments on another post as well.

     I have volatile blood sugar (managed very well with PHD), with extreme sensitivity to fructose, and so I limit my fructose/sugar carbs even more than Paul suggests. If I don’t manage it, I have very bad emotional swings.

     Reply
   • Paul Jaminet June 26, 2013 at 7:54 pm

     Hi Michael,

     As elizabethe indicates, negative emotions from carbs are indicative of gut dysbiosis. Feeding bad microbes leads to inflammation which shifts the brain toward depression.

     The solution is to heal the gut and improve the gut flora. Carbs are important for gut barrier integrity and immune function, but you should choose carb sources that give minimal symptoms, and choose fiber intake carefully. Eat fermented foods for probiotic flora and liver and sunshine for vitamin A and D. In severe cases, fecal transplants may be the best solution.

     Reply
3. David Andrews June 27, 2013 at 4:31 pm

   Here’s a poignant TED talk about the connection between diet and diabetes that reflects (I suspect) what many of us feel…

   http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html

   Reply
4. Shauna June 27, 2013 at 9:59 pm

   As I’ve been implementing aspects of the PHD, I’m noticing that I feel poorly whenever I increase my saturated fat intake to more than trace amounts – I’ll get a headache, blurry vision, fatigue, and mild anxiety. This experience holds whether I eat beef, poultry, egg, or coconut oil. I feel much better eating only lean poultry and fish, and cooking everything in olive oil.

   I got sick three years ago with joint pain and neurological issues, and have been told by 2 neurologists and an opthamologist that my case sounds like a sub-clinical demyelinating disease like MS.

   Given that my neurological symptoms started initially after an overnight switch from a low-fat vegan diet to a high-fat paleo-type diet, and given that there seems to be considerable evidence that a diet as low as possible in saturated fat is therapeutic for MS (Swank diet, Best Bet Diet, etc.), I am curious as to whether you have any thoughts as to whether it might be possible that some people’s chronic infections are exacerbated by saturated fats. Could there be some cases where saturated fats (even medium-chain) are detrimental?

   Thanks!

   Reply
   • Paul Jaminet June 28, 2013 at 2:59 am

     Hi Shauna,

     I’ll have to think about that one. Medium-chain fats can cause trouble in protozoal/parasitic infections by creating ketones which feed them. When saturated fats of all kinds cause trouble, however, it has to be by increasing oxidative stress. Usually damage from oxidative stress is mediated through polyunsaturated fat oxidation so reducing omega-6 fat intake becomes crucial; probllems also usually indicate a deficiency of antioxidant minerals like zinc, copper, and selenium.

     Exactly what the link is between a disease like MS and oxidative stress, I would have to research.

     But note that the oxidative stress is only generated by saturated fat when there is an excess of energy. So you should be able to eat saturated fat if the diet is slightly calorie restricted.

     Nothing wrong with eating poultry, fish, and olive oil however.

     Reply
     • Shauna June 28, 2013 at 7:37 am

       Paul, thanks so much for the reply. I’ll work on further restricting omega-6.

       Reply
     • marcus volke July 22, 2013 at 10:08 am

       I’m confused Paul, why should saturated fat specifically increase oxidative stress? My understanding is that all calories increase oxidative stress because calories have to be oxidized to be utilized; but that carbohydrates do so the most, which we know because they are associated with a higher output of Reactive Oxygen Species.
       Calorie for calorie, wouldn’t saturated fat be safer in this respect then both carbs and PUFA’s?

       Reply
       • Paul Jaminet July 22, 2013 at 1:08 pm

         Hi Marcus,

         The most ROS is produced when there is a cellular energy excess (so ATP levels saturate) and the diet is saturated fat.
         Next most when carbohydrate is eaten.
         The least ROS is produced when there is a cellular energy scarcity (so ATP levels non-saturated) and the energy source is saturated fat.

         Saturated fat is healthier than carbs because it gives greater dynamic range in ROS production so the ATP status and metabolism are more closely linked, thus ATP status is better regulated.

         Still, in any short term study, on people eating an obesogenic/diabetes-promoting diet, saturated fat will generate the most ROS, even though it is healthiest in the long run.

         Reply
         • marcus volke July 26, 2013 at 11:07 pm

           I think I need to get your new revised book because my copy said carbs produce the most ROS!
   • George @ the High Fat Hep C Diet July 2, 2013 at 9:39 pm

     Have you been tested for vitamin B12 deficiency, or had a high-dose B12 injection? (the reaction to this probably the best guide to deficiency)
     If you were B12 deficient then switched to high fat you would not be able to break down some fats, such as odd-chain fatty acids, phytanic acid, till B12 was replete. In the meantime this could do some damage.

     Reply
     • Shauna July 3, 2013 at 8:02 am

       George, thanks for the reply. I’ve been supplementing methylcobalamin, but it’s possible I’m not absorbing it, since I know I’ve got a leaky gut. I should get my B12 level tested.

       Reply
5. Beata June 28, 2013 at 8:30 am

   Dear Paul,

   My question is about the bacterial infection. When there is one that is “hidden” and long standing, will the blood tests for white blood cells (or other indicators) come up positive?

   Reply
6. Donna June 28, 2013 at 11:31 am

   Paul, Mercola seems to be recommending 100 mcg Vit K for every 1000 IU of Vit D you take. So, for eg., if I take 5000 IUs of D, I would need 500 mcg of K. I know of no one else suggesting that high a dose of K. Anyone aware of whether such a high dose is good? safe? Thanks.

   Reply
   • Paul Jaminet June 28, 2013 at 6:45 pm

     Hi Donna,

     High doses of vitamin K2 haven’t really been tested apart from the Japanese cancer trials – they didn’t report negative effects but I don’t think that can be considered conclusive, compared to cancer any effect is going to be small.

     In general we think they are safe, there’s no known mechanism of toxicity. So I don’t think it’s wrong to do that, but I do think it’s unnecessary, especially if you eat fermented foods, green leafy vegetables, liver, aged cheese, and such.

     Reply
7. Beata June 29, 2013 at 5:40 am

   Dear Dr. Jaminet,
   Would you kindly attend to my question. I am beginning to feel a little left out since none of my questions have ever been addressed. I hope you will notice this one and share your opinion. Thank you in advance.

   My question is about the bacterial infection. When there is one that is “hidden” and long standing, and can only be suspected by the symptoms (insomnia and anxiety) will the blood tests for white blood cells (or other indicators) come up positive?

   Reply
   • Paul Jaminet June 29, 2013 at 8:08 am

     Hi Beata,

     I’m not sure what blood tests you are talking about. There’s no reason for white blood cell counts to be abnormal in chronic infections. Unusual white blood cell counts indicate acute events or, if they are high, sometimes a malignant transformation.

     Reply
     • Beata June 29, 2013 at 10:20 am

       Thank you very much! I am very grateful for your reply.

       Reply
8. TR June 29, 2013 at 10:54 am

   Good Day Paul- The following was in a recent post by Dr. Davis. Dead right-on or over-hyped?

   “Compared, say, to gumdrops (sucrose, high-fructose corn syrup, flavorings, food coloring), wheat contains a spectrum of unhealthy components that go far beyond that of sugar and carbohydrates. No other food contains the gliadin protein that yields appetite-stimulating opiates and increases intestinal permeability leading to autoimmune conditions. No other food contains the powerful lectin of wheat, wheat germ agglutinin, that is a direct bowel toxin, mimics the effect of insulin upon absorption into the bloodstream, and triggers inflammation powerfully. No other food contains unique allergenic proteins created by the genetics manipulations of the 1970s that changed the amino acid structure of alpha amylase inhibitors and others that underlie asthma and skin rashes (though soy, corn, and peanuts may have similar allergenic issues).”

   Reply
   • Paul Jaminet June 29, 2013 at 4:59 pm

     Well, it’s hard to say. Wheat certainly has toxins that sugar lacks, but it also has some nutrition, so how you would rate it as a food depends on how damaging you think the toxins are. I’m in the camp that wheat toxins may be pretty severe, at last in a significant fraction of the population that doesn’t detoxify them well or is sensitive to them. So I would largely agree, but most nutritionists would not. I think some of his claims are exaggerated, eg appetite effects.

     Reply
9. marcus volke June 30, 2013 at 3:41 am

   Hi Paul,

   My girlfriend is taking a high dose iodine supplement from one of your recommended sellers. The dose is 12.5mg a day. I just read an article recently on dr.mercola’s website warning against iodine supplements that exceed 500-1000 mcg a day. her dose is more than 12 times that amount! Here is the article – http://articles.mercola.com/sites/articles/archive/2013/06/29/iodine-deficiency-risk.aspx?e_cid=20130629_DNL_art_2&utm_source=dnl&utm_medium=email&utm_content=art2&utm_campaign=20130629

   What do you think? Is it safe or not? Thanks.

   Reply
   • Paul Jaminet June 30, 2013 at 7:32 am

     Hi Marcus,

     A year ago we reduced our iodine recommendation to 225 mcg per day and we now class the 12.5 mg as a therapeutic supplement which might possibly be helpful in certain disorders (especially bromine toxicity or some infections) but isn’t recommended for routine use.

     I think the high dose is a bit risky so better to go lower unless you have a good reason for high doses.

     Reply
     • marcus volke July 1, 2013 at 9:58 am

       ok, thanks for the reply 🙂

       Reply
10. Brooke June 30, 2013 at 6:32 pm

    Hi Paul,
    I am loving your book so far! If you have a moment would you clarify why you reccomend considering the potassium: fructose ratio while choosing the best fruits rather then the glucose: fructose ratio or just the fruits with the least amount of fructose.
    Thanks!!

    Reply
    • Paul Jaminet July 2, 2013 at 3:57 am

      Hi Brooke,

      Well, there’s no single parameter which will fully characterize the healthfulness of fruits. Potassium is an important nutrient found in all fruits that low-carb dieters are often low in; fructose is an item found in all fruits that people often get too much of; so shifting toward more potassium and less fructose should be beneficial for most. It was hard to think of another single parameter that would be as useful. However, I don’t consider that a crucial parameter to optimize. We like blueberries a lot which are low. I don’t think it’s bad to eat apples or pears.

      Reply
11. Chris June 30, 2013 at 8:09 pm

    Hi,

    I have a question regarding the Metametrix parasite screening. Can anyone confirm that they only screen for the eight protozoans and eight worms listed here http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-parasitology?t=clinicianInfo
    I thought they test for every parasite they know the DNA of, but I don’t find the above list very comprehensive.

    Reply
12. Irene Cross July 1, 2013 at 10:48 am

    Dear Paul, I have done a very stupid thing and now I’m dealing with my self inflicted problems. In May of 2012 a trusted medical source told me to stop my multi-vitamins because they contained copper. I have wet macular degeneration in one eye and he said he’d been reading reports that copper (and iron) drive AMD. I did it, but I continued to take zinc supplements-first 30 mg. and then upped the dosage to 60 mg. for a period, because of the AREDS1 study and then the AREDS2 that came out last year. Not long after, my ferritin level began to fall and now it’s at 10. Then in May I had to stop running because of excruciating pain in my buttocks and the back of my thigh. Now even sitting and walking are painful. Constant small cramps in my legs and ankle pain. My gait is altered. Many symptoms that are similar to MS. X-rays of my hips and pelvis revealed severe arthritis in my lumbar spine-it is brand new. I finally began to do some research (due diligence that I neglected to do earlier) and found that this may in fact be due to a profound copper deficiency. I know this is an imposition, but I’d like to ask you to read the Medsape article that I’m sending the reference to. The patient reported on was started on 6 mg of copper for 1 week, then 4 mg for one week, and finally 2 mg to get to repletion. Apparently, her anemia resolved, but not the neurological issues. I started the same regimen yesterday, but with 5 mg for this next week. I am so scared, and so sorry for my stupidity! Any advice you might offer would be gratefully received. Thank you. From Nature Clinical Practice Neurology
    When Metals Compete: A Case of Copper-Deficiency Myeloneuropathy and Anemia
    Rebecca I. Spain, MD ; Thomas P. Leist, MD ; Eduardo A. De Sousa, MD
    Posted: 02/05/2009; Updated: 02/01/2009
    Summary and The Case
    Summary

    Background: A 47-year-old woman with an otherwise unremarkable medical history was referred to the multiple sclerosis clinic by her primary neurologist for evaluation of a 2-3 year history of progressive knee and back pain, weakness, paresthesias, sensory loss, ataxia, and falls. During the same period, she had received blood transfusions for unexplained anemia and leukopenia. She had been wearing dentures for many years.
    Investigations: Physical examination, neurological examinations (assessments of reflexes, gait, proprioception, and sensitivity to temperature, pinprick and vibration), neurophysiological studies (visual and brainstem somatosensory evoked potentials, nerve conduction studies and electromyography), T2-weighted MRI of the brain and spine, cerebrospinal fluid analysis and serum evaluations.
    Diagnosis: Myeloneuropathy and anemia due to copper deficiency, secondary to zinc overload associated with long-term use of denture cream with a high zinc content.
    Management: Change to a low-zinc denture cream and oral copper replacement.

    The Case

    A 47-year-old woman with an otherwise unremarkable medical history was referred to a multiple sclerosis (MS) clinic by her primary neurologist for investigation of a 2-3 year history of progressive knee and back pain, weakness, paresthesia, sensory loss, ataxia and falls. During the same period, she had been treated with wholeblood transfusions for unexplained anemia and leukopenia. Bone marrow biopsies demonstrated nonspecific changes.

    Investigations performed before her presentation to the MS clinic included an unremarkable serum work-up for infections, malignancy, vitamin deficiencies, and rheumatologic and collagen vascular diseases. Cerebrospinal fluid analysis showed increased myelin basic protein but no evidence of inflammation or infection. The patient self-reported that the results of a nerve conduction study and electromyography early in her disease course were normal. A T2-weighted MRI scan of the spine performed during this prior investigation had revealed a contiguous, longitudinal, subtly increased signal throughout the dorsal cervical and thoracic spine that did not show enhancement after administration of gadolinium (Figure 1A). MRI of the brain and electroencephalographic assessment of visual, as well as brainstem somatosensory evoked potentials had produced unremark­able results. Posterior tibial somatosensory evoked potentials, recorded by electroencephalography, were abnormal above the level of the lumbar spinal cord.

    Figure 1. (click image to zoom) T2-weighted MRI scans of the patient’s cervical and upper thoracic spine at diagnosis of copper-deficiency myeloneuropathy and after 5 months of treatment. (A) A contiguous, longitudinal, subtly increased signal that did not show enhancement after administration of gadolinium was present throughout the dorsal cervical spine and the thoracic spine (white arrows). (B) This signal was not as prominent after 5 months of copper supplementation.
    On presentation to the MS clinic, the patient’s physical examination was notable for reduced muscle bulk and tone, associated with generalized muscle weakness of arms, legs and neck flexors (Medical Research Council grade 4 out of 5), which was worse distally (Medical Research Council grade 3 out of 5). Reflexes were normal in the patient’s arms, but were decreased at the patellae, and absent at the ankles; a plantar flexion response was evident. Sensations of temperature, pinprick, vibration and proprioception were substantially reduced below the patient’s knees. Sensitivity to temperature and pinprick was decreased in her hands, but intact to vibration and proprioception. Her gait was markedly ataxic and a Romberg test indicated peripheral ataxia.

    In the MS clinic we repeated the nerve conduction study and electromyography, which demonstrated a severe sensory neuropathy without radiculopathy or myopathy. The patient’s hematological profile continued to show anemia, leukopenia and absolute neutropenia ( Table 1 ). Serum analysis established low copper and ceruloplasmin levels, and high zinc levels; consequently, the patient was diagnosed as having copper-deficiency myeloneuropathy and anemia. On further questioning, the patient reported use of a denture cream that contained high levels of zinc (approximately 34,000 µg/g).[1]

    Table 1

    Laboratory Findings for fhe Patient at Diagnosis of Copper Deficiency, and After 2 Months of Copper Supplementation

    The patient was advised to switch to a lowzinc denture cream and started oral copper gluconate supplementation at 8 mg daily, which was tapered to 2 mg daily over a period of 1 month (this regimen was suggested by N Kumar before publication of his research article on this topic[2]). Chelation therapy to reduce her zinc levels was not considered necessary. Her serum levels of copper, ceruloplasmin and zinc, and her blood counts had normalized by 2 months after initiation of treatment ( Table 1 ). The increased, longitudinal, spinal-cord signal on MRI (Figure 1A) had improved at 6 months (Figure 1B) and had resolved fully by 18 months. Her neurological features stabilized, but these and her neurological signs still had not improved at her most recent visit, after 18 months of copper supplementation. Unfortunately, she did not tolerate symptomatic medications for pain. She was advised to continue indefinitely a daily multivitaminthat contained at least 2 mg of copper.

    Table 1

    Laboratory Findings for fhe Patient at Diagnosis of Copper Deficiency, and After 2 Months of Copper Supplementation

    Discussion of Diagnosis
    Copper is an essential trace element, and diseasesin animals and humans associated with altered copper levels have been recognized since the early 20th century. A disease caused by nutritional copper deficiency, enzootic ataxia (also termed swayback), was first described in sheep in 1937,[3] and has since been found in other domestic and wild animals. Nutritional deficiencies of copper in human adults are rare unless a condition is present that affects the uptake or metabolism of copper, or dietary intake is markedly deficient in copper, such as with some parenteral feeding formulations.[4] Hereditary copper deficiency in humans, known as Menkes syndrome, is associated with mutations in the ATP7A gene, which encodes copper-transporting ATPase 1. Such mutations disrupt the supply of copper to copper-dependent intracellular proteins and elimination of excess copper from cells.[5] Progressive hepatolenticular degeneration (Wilson disease) is associated with defects in the ATP7B gene, which encodes a copperefflux-pump protein. Symptoms result from the accumulation of copper in the liver and brain.[6]

    Copper has diverse functions in the body and symptoms of iatrogenic and acquired copperdeficiency vary widely. Copper is required by various proteins and enzymes, including ceruloplasmin (a copper-dependent oxidase that promotes hematopoesis via oxidation of iron [Fe2+] to a bioavailable form [Fe3+]), cytochrome C oxidase (the last enzyme in the mitochondrial electron-transport chain, which is involved in ATP synthesis), lysyl oxidase (an extracellular enzyme that induces cross-linking of collagen and elastin in connective tissue, bone and vasculature, owing to its action on lysine residues), monoamineoxidases and dopamine β-hydroxylase (which are involved in catecholamine metabolism and biosynthesis, respectively).[7]

    The hematological effects of copper deficiency include sideroblastic anemia, leukopenia and neutropenia.[7] Acquired copper deficiency is also thought to affect cardiovascular and bone health.[8] Effects on the nervous system have been characterized in the past 7 years;[9] they include myeloneuropathy with spastic gait, distal parasthesias and sensory ataxia, which closely mimic the symptoms and radiographic findings in patients with subacute combined degeneration associated with vitamin B12 deficiency.[10] Reflexes can be increased or depressed, and bladder symptoms can be present. Rarely, copper deficiency is associated with isolated demyelination of the optic nerve and in the CNS, peripheral neuropathies, or myopathy.[10]

    High concentrations of zinc have long been known to lead to copper deficiency, sideroblastic anemia and neutropenia,[11] but have only been implicated in copper-deficiency myeloneuropathy in the past few years. Zinc interferes with the absorption of copper from food. High intakes of zinc can result in increased expression of endogenous chelating proteins such as metallothioneins that have a greater affinity for copper than for zinc. Another effect is the sequestration of copper in enterocytes of the stomach and proximal duodenum, which are sloughed off and eventually excreted in the feces.[1] Possible reasons for zinc overload include excessive zinc replacement during parenteral or enteral nutritional support, such as during hemodialysis, and excessive oral intake of supplemental zinc.[11] Denture fixatives that are high in zinc can also lead to accidental, excessive ingestion,[1] as had happened in the patient we describe.

    Malabsorption of copper can occur in patients who have chronic gastrointestinal diseases or those who have previously undergone gastrointestinal surgery to treat such diseases or to attain weight loss.[9] Gastric-bypass surgery is linked to multiple nutritional deficiencies that can lead to neurological symptoms, including myeloneuropathy associated with low serum levels of copper, vitamin B12, or both.[12] A notable range of times between the gastric procedure and onset of neurological symptoms has been reported, from less than 1 year[2] to 24 years.[13] The exact pathological mechanism or mechanisms that lead to copper malabsorption after gastrointestinal surgery remain to be elucidated. Excessive urinary excretion of copper represents another cause of deficiency and has been reported in patients with glomerulonephritis.[14]

    Differential Diagnosis
    Various conditions must be excluded by a variety of methods to diagnose copper-deficiency myeloneuropathy correctly ( Table 2 ). Blood levels of vitamin B12, folate, methylmalonic acid, homocysteine, vitamins A, D, E, and K, iron, and calcium should be measured to exclude concomitantnutritional deficiencies. Vitamin B12 deficiency must be carefully excluded on the basis of blood levels of vitamins, methylmalonic acid and homocysteine as well as erythrocyte volume. Concurrent iron deficiency, however, can mask the increased erythrocyte volume that is normally characteristic of vitamin B12 deficiency. A medical history of gastrointestinal surgery, malabsorption states, presence of dentures, and a review of medications and dietary supplements can hold the key to diagnosis of copper-deficiency myeloneuropathy. Frequently, however, no such precipitating factors can be identified.[2]

    Table 2

    Distinguishing Features of, and Diagnostic Tests for, Disorders That Should Be Considered in the Differential Diagnosis of Copper-deficiency Myeloneuropathy

    In some cases, bone-marrow morphology might demonstrate vacuoles in myeloid and erythroid precursor cells,[4] ringed sideroblasts[11] and iron deposits in plasma cells.[4] The patient’s previous bone-biopsy results were not available for us to assess whether these features were present. Measurements of 24 h urinary copper excretion and a neuro-ophthalmologicexamination for Kayser-Fleischer rings are not necessary unless Wilson disease is suspected. Electrophysiological studies might have unremark­able findings, or can show axonal neuropathy[10] (which can be pure motor, pure sensory or mixed sensory and motor types). Abnormal somatosensory evoked potentials point to a lesion in the spinal cord, and abnormal visual-evoked potentials have been reported in patients with copper-deficiency myeloneuropathy,[2] but the results of both tests were unexceptional in our patient. Abnormalities on T2-weighted MRI can include areas of increased signal in the dorsolateral cervical and thoracic spinal cord, with or without swelling.[15,16] Our patient had a slight signal increase in the dorsal cervical and thoracic spine and no swelling. Nonspecific white-matter changes can be sometimes be seen on brain MRI;[1,10] such changes warrant investigation in further clinical studies to determine the nature of their association with copper deficiency.

    In the case we report, we confirmed the diagnosis of copper-deficiency myeloneuropathy by the presence of decreased copper and ceruloplasmin levels in serum. Other evidence that supported this diagnosis included the presence of a normocytic anemia (microcytic and macrocytic anemia have been reported elsewhere[9]), leukopenia with neutropenia, and elevated serum levels of zinc.

    Treatment and Management
    A treatment protocol for copper-deficiency myeloneuropathy has been proposed[2] that includes a short period of replacement with high oral doses of copper, in the form of copper gluconate or copper chloride, (e.g. 6 mg per day for 1 week, followed by 4 mg per day for 1 week) followed by long-term supplementation with 2 mg per day oral copper thereafter to maintain normal serum levels.[2] Some patients with a long or recurrent history of copper deficiency have been reported to require increased doses of copper replacement in order to maintain normal serum copper levels.[13] Patients can also be advised to increase their dietary intake of foods that are high in copper, such as legumes, shellfish, chocolate, mushrooms, liver, and nuts; however, whether dietary changes alone can normalize serum copper levels is unknown.

    Concomitant nutritional deficiencies should also be treated, and use of any high-risk agents such as the high-zinc denture cream that was used by the patient described here should be investigated and, if identified, stopped or switched to low-zinc alternatives with counseling about how to avoid other sources. Patients who are taking copper supplements to treat copperdeficiency myeloneuropathy should undergo periodic monitoring of their hematological profile, including measurements of serum levels of copper, ceruloplasmin, and zinc to evaluate the adequacy of copper supplementation.

    Hematological abnormalities related to copperdeficiency myeloneuropathy always resolve with copper supplementation.[14] Neurological signs generally stabilize but do not improve, although some symptoms might show subjective sensory improvement.[14]

    Conclusions
    Copper deficiency is an uncommon cause of myeloneuropathy, but populations at the highest risk are elderly people, patients who have undergone gastric-bypass surgery, those with renal disease or malabsorbtion states, and individuals who use supplemental zinc and/or over-thecounter medications or preparations that are high in zinc. Differential diagnosis is essential because a broad range of conditions have symptoms that overlap with those of copper deficiency. Given the insidious clinical presentation of the progressive myeloneuropathy, confirmation can be delayed for years. Investigation and treatment of copper deficiencies should not be delayed because, once present, the neurological symptoms of copper deficiency can be stabilized but are generally permanent.

    Acknowledgements

    We thank the patient mentioned in this article for giving written permission for the presentation of her medical history and case. Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

    Reprint Address

    Rebecca I Spain, Multiple Sclerosis Center of Oregon, Oregon Health Sciences University, Mail code: CR 120, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA; Email: spainr@ohsu.edu

    References
    Nations SP et al. (2008) Denture cream: an unusual source of excess zinc, leading to hypocupremia and neurologic disease. Neurology 71: 639-643
    Kumar N (2006) Copper deficiency myelopathy (human swayback). Mayo Clin Proc 81: 1371-1384
    Bennetts HW and Chapman FE (1937) Copper deficiency in sheep in Western Australia: a preliminary account of the aetiology of enzootic ataxia of lambs and an anaemia in ewes. Aust Vet J 13: 138-149
    Chen CC et al. (2007) Clinicopathological analysis of hematological disorders in tube-fed patients with copper deficiency. Intern Med 46: 839-844
    Danks DM et al. (1972) Menkes’s kinky hair syndrome. An inherited defect in copper absorption with widespread effects. Pediatrics 50: 188-201
    Wilson SAK (1912) Progressive lenticular degeneration: a familial nervous disease associated with cirrhosis of the liver. Brain 34: 295-509
    Turnlund JR (2000) Copper. In Modern nutrition in health and disease, 241 (Eds Shils ME et al.) Philadelphia: Lippincott
    Relling DP et al. (2007) Dietary interaction of high fat and marginal copper deficiency on cardiac contractile function. Obesity (Silver Spring) 15: 1242-1257
    Schleper B and Stuerenburg HJ (2001) Copper deficiency-associated myelopathyin a 46-year-old woman. J Neurol 248: 705-706
    Kumar N et al. (2004) Copper deficiency myelopathy produces a clinical picture like subacute combined degeneration. Neurology 63: 33-39
    Simon SR et al. (1988) Copper deficiency and sideroblastic anemia associated with zinc ingestion. Am J Hematol 28: 181-183
    Juhasz-Pocsine K et al. (2007) Neurologic complications of gastric bypass surgery for morbid obesity. Neurology 68: 1843-1850
    Prodan CI et al. (2004) Relapsing hypocupraemic myelopathy requiring high-dose oral copper replacement. J Neurol Neurosurg Psychiatry 77: 1092-1093
    Bartner R et al. (2005) Pancytopenia, arthralgia and myeloneuropathy due to copper deficiency [German]. Med Klin (Munich) 100: 497-501
    Yaldizli O et al. (2006) Copper deficiency myelopathy induced by repetitive parenteral zinc supplementation during chronic hemodialysis. J Neurol 253: 1507-1509
    Ferrara JM et al. (2007) Subacute combined degeneration due to copper deficiency. J Neuroimaging 17: 375-377
    Nat Clin Pract Neurol CME © 2009 Nature Publishing Group

    Contents of When Metals Compete: A Case of Copper-Deficiency Myeloneuropathy and Anemia
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    When Metals Compete: A Case of Copper-Deficiency Myeloneuropathy and Anemia
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    Reply
13. Irene Cross July 2, 2013 at 8:21 am

    Dear Paul, I am so embarrassed that I sent such lengthy post. I’m sorry to have imposed. When I wrote it I was distraught and I apologize. Sincerely, Irene.

    Reply
    • Paul Jaminet July 2, 2013 at 8:41 am

      It’s quite alright Irene. I’m on vacation this week but if I can find time to understand the issues, I’ll respond.

      Reply
14. BSG July 2, 2013 at 4:33 pm

    Hello. I always appreciate hearing Paul’s (and other PHD’ers) thoughts on the latest Red meat is bad studies:
    “After multivariable adjustment, participants who increased their intake of red meat (beef, pork, or lamb) by one-half serving daily over a 4-year period had a significant, 48% increase in diabetes risk during the subsequent 4 years” – See more at: http://www.jwatch.org/fw107623/2013/06/18/increases-red-meat-intake-linked-heightened-diabetes-risk

    My first guess was they also ate more carbs and suger but there was a multivariable adjustment.

    Best!

    Reply
    • Paul Jaminet July 2, 2013 at 7:39 pm

      Hi BSG,

      My belief is that the increased risk is specific to pork and is probably caused by infectious diseases carried in pork, such as hepatitis E virus and Yersinia. That’s if it’s due to meat at all and not confounding factors.

      Reply
    • marcus volke July 5, 2013 at 9:26 am

      That study is complete nonsense. Like most studies on red meat consumption that fail to distinguish between unprocessed vs processed, cured and blackened red meat. Obviously if you eat more hot dogs, hamburgers and high nitrate cured meats you are going to raise your risk of health problems.
      I don’t believe its pig meat perse like dr.jaminet suggested but processed meat. See this link – http://pt.atkins.com/blogue/colette-heimowitz/meat-of-the-matter.html

      Reply
15. Frank July 3, 2013 at 10:56 am

    Hello Paul,
    i read your book and have a question about the circadian rhythm. I have to work 3 nights in a row per month in a hospital. Can a body deal with that and whats your advice about eating,sleeping in these days?
    Frank

    Reply
16. Samson July 3, 2013 at 10:01 pm

    Hi Paul;

    I’ve been reading about Candida for a while and it seems a good explanation to how I’ve been feeling.

    There is one symptom that makes me unsure, however, and that is sugar cravings. I’ve noticed that when I stop eating sugar for 12 hours, then try to consume anything sugary, it tastes terrible and I have no desire to keep eating it.

    I’d like to try ketosis, but won’t if I think I have candida because I know you don’t recommend it.

    What do you think this means?

    Thank you!

    Reply
    • tam July 4, 2013 at 8:49 am

      I’ve been going along with http://thecandidadiet.com lately, so oat bran, quinoa, and buckwheat (millet is goitrogenic), meat, and non-sugary vegetables. After a meal I have 1/8 tsp olive oil or coconut oil. I use the heart rate app on iphone and I notice my pulse stays elevated unless I take the oil. I just went through an insane period of sugar cravings, but I resisted. I think I’m getting better, knock on wood. Don’t take acetyl-glutathione.

      Maybe it’s not just candida, but a whole constellation of sugar eating flora?

      http://olsonnd.com/sugar-and-candida/

      Reply
17. Brooke July 4, 2013 at 12:30 pm

    Any thoughts on chronicly chapped lips?

    Thanks!!

    Reply
    • George @ the High Fat Hep C Diet July 7, 2013 at 12:41 am

      Problems with the mouth usually indicate riboflavin (B2) deficiency for some reason, this may also be the case with lips. Vitamin E will help them heal (break open a capsule and smear it on).

      Reply
18. Stephanie July 4, 2013 at 9:31 pm

    Hi Paul,

    Do you think coconut oil consumption while fasting can cause histamine release? I’ve suspected for some time that I have a histamine intolerance and one of my symptoms is sneezing after consuming some foods high in histamine (e.g., dark chocolate). I’ve also noticed that when I eat coconut oil during a fast, I sneeze afterwards; this makes me unsure whether I should consume it or not. Any thoughts?

    Reply
19. Claire July 4, 2013 at 10:54 pm

    Hi Paul!

    I have been following the PHD for about 6-7 months. (All supplements included except for egg yolks because of an allergy). It has been wonderful. I have found, however that my PMS symptoms have worsened. In addition, I seem to constantly be dealing with topical skin infections. (Acne, topical yeast, itchy scalp). I’m just curious if you have suggestions for either of these problems.

    Thanks!

    Claire

    Reply
    • Eszter August 7, 2013 at 5:56 am

      Hi Claire,

      I have the same experience. In my case the worsened PMS symptoms were caused by white rice. I had to eliminate it and stick to sweet potato as the only safe starch in my diet and the symptoms were gone.

      Hope you’ll get better soon,
      Eszter

      Reply
20. tam July 5, 2013 at 2:41 pm

    I saw the healer listed for NJ, and she’s already helped me with a candida enzyme. Thanks, Paul

    Reply
21. Spar July 8, 2013 at 3:43 pm

    Paul, any danger of L-Arginine supplementation? if not would you recommend it?

    Reply
    • Paul Jaminet July 8, 2013 at 9:40 pm

      I wouldn’t recommend it for healthy people. Balanced protein is generally the way to go. High arginine:lysine diets have been found to be therapeutic for certain conditions, but a high arginine to lysine ratio promotes viral infections and alters various aspects of biology.

      Reply
      • Spar July 14, 2013 at 12:23 am

        Paul, I assume same danger with Citrulline Malate?

        Reply
        • Paul Jaminet July 14, 2013 at 9:12 am

          No, while arginine can go to citrulline, citrulline can’t go back to arginine, so it wouldn’t have that effect. I think it’s a good athletic supplement.

          Reply
          • Spar July 14, 2013 at 3:47 pm

            Thank you so much
22. Frank July 9, 2013 at 4:37 am

    Hello Paul,
    i read your book and have a question about the circadian rhythm. I have to work 3 nights in a row per month in a hospital. Can a body deal with that and whats your advice about eating,sleeping in these days?
    (2nd try)
    Frank

    Reply
    • elizabethe July 9, 2013 at 9:37 am

      Hi Frank,

      Paul answered this exact question — how to manage circadian rhythms for people on a night shift or a third shift — at great length in a recent podcast. It was the one at not just paleo, I think:

      http://notjustpaleo.com/?p=1914

      The basic and oversimplified answer was that on those days you should pretend your nights are you days and your days are you nights. You do all your normal daytime activities at night, including eating, socializing, and exercising. It’s a good podcast. I sent a link to my sister who is a nightshift nurse.

      Reply
      • Frank July 10, 2013 at 7:09 am

        thx a lot, elizabethe

        Reply
        • elizabethe July 12, 2013 at 9:18 pm

          touching back in just to say Michelle at nom nom paleo just put a good post up on this topic with lots of links.

          http://nomnompaleo.com/post/55156756199/surviving-the-night-shift

          but of course this is totally unnecessary because everyone here reads nom nom paleo right?!?! right?! =)

          Reply
23. Jonathan July 9, 2013 at 1:47 pm

    Does anyone continue to make fermented veggies during the summer months? I’m guessing the recipe is the same with the exception of a shorter ferment time?

    Reply
    • Ellen July 9, 2013 at 5:50 pm

      Yes, shorter time.

      Reply
24. BSG July 12, 2013 at 1:28 pm

    Hi. I am not sure if this has been covered before. Is any one aware of a connection between gluten and earaches, adenoid and or tonsil inflammation in children? Or some other connection besides gluten? I can’t find it now but I recently read something stating that 40% of children will have tubes in their ears at some point to avoid ear aches. Crazy that it might just be accepted as the norm. I had my tonsils and adenoids removed to help reduce earaches and sore throats that I experienced off and on into my late teens. I have read somethings hinting at gluten. Just wondering if anyone is aware of more concrete studies/information out there. Hoping to avoid all of the above with my son if I can. Keeping my son away from gluten at day care is going to be really really tough. : ( Thank you!

    Reply
25. Marianne July 13, 2013 at 8:32 pm

    Hi! Thanks for your book and website. For 25 years I’ve suffer from chronic, insidious candida albicans (vaginal thrush), which tends to flare up each month in line with my hormonal cycle. Would you recommend any modifications to the Perfect Health Diet for controlling candida? (Admittedly, I find the strict anti-candida diets very difficult to stick to, especially as I work full-time. But, armed with my trusty rice cooker, I’ve just enjoyed two days on your diet, with no sugar cravings! Incredible!)

    Reply
    • tam July 13, 2013 at 11:36 pm

      In an effort to reduce sugar, watch out for potassium and vitamin C deficiencies. Maybe stick with potatoes and bell peppers.

      Reply
26. marianne July 13, 2013 at 8:38 pm

    hi there. Thanks for your book and website. I’ve just enjoyed a couple of days on your diet! 🙂 Do your recommend any modifications to the Perfect Health Diet for women with chronic, cyclical candida albicans (vaginal thrush)?

    Reply
27. tam July 18, 2013 at 6:55 am

    If someone is deficient in potassium, and eats a food high in vitamin C, is there a reason the heart rate would go up?

    Reply
28. Ann C July 18, 2013 at 12:26 pm

    Boy, did I mess up. I have a history of chronic vaginal yeast infections, vulvodynia and interstitial cystitis. After the best specialists in the medical field could not help me for 7 years, I saw a very talented naturopath who did. I’ve been completely free of all flair ups for three full years! Unfortunately, all these years made me think I was cured. 🙁

    First mistake: in a botched attempt to lose ten pounds I went low carb/paleo-ish which meant I started eating bacon, nuts, aged cheese, all foods I don’t usually eat. Second mistake: I read about the importance of fermented foods to improve the gut biome. OK, then! I added lots of fermented foods, kombucha, sauerkraut, miso. After six days I had one of the very worse flair up of interstitial cystitis and vulvodynia I’ve ever had. 🙁 I missed work, could hardly cope with the pain, blood in my urine, yeast infection.. All my great progress gone in one week. That was a month ago and I’m only starting to feel better, but my intestines are a mess, severe constipation and bloating. Now I’m trying to figure out how to eat the PHD while reducing oxalates and high histamine foods (all those fermented foods are totally bad for me!) and trying to reduce candida build up again. (I’ve got diflucan to take which will help). Oh and to top if off, I was just diagnosed with mild gout in one toe, something I’ve never had before. Too much high protein on the paleo, I guess???… Holy cow, from good health to a big fat mess in one week! A cautionary tale, for sure.

    Now..what the heck to eat??

    Reply
    • Natalie Campbell July 21, 2013 at 7:23 pm

      Dear Ann, Sounds like a killer yeast infection that you stirred up.. You might consider the ‘4 stages’ diet designed by Bruce Semon MD. at http://www.nutritioninstitute.com. They don’t post the diet on the site so you have to buy the book- Feast without Yeast, or An Extraordinary Power to Heal. Best wishes!

      Reply
      • Ann C July 21, 2013 at 8:47 pm

        Thanks Natalie, I’ll look into it.

        Reply
        • Natalie Campbell July 26, 2013 at 10:04 pm

          Dear Ann, I wish more people would respond to your very interesting letter.[like Paul?] There is so much conflicting info out there. By the way I realize the 4 stages diet I suggested has too many oxalates in their diet. For example there are two main opposite approaches for candida: the body ecology diet which uses lots of fermented foods, and the 4 stages diet which uses no fermented food. I guess you know which side you are on.
          Then there is the proportion of carbohydrate in the diet. Most candida diets appear to be low in carbs but then the PHD comes along and says that ketosis should be avoided in fungal infections p.349.
          How did your naturopath cure you before? Can’t you do that again? Natalie

          Reply
          • Ann C July 27, 2013 at 11:26 am

            Natalie,

            I know! It is very confusing trying to balance low oxalate (I know low oxalate is important because I have had extremely painful flair ups within three hours of eating a handful of nuts), low histamine (I take zantac as a Histamine II blocker which was part of the cure originally) and then the yeast for which I have diflucan as needed as well as a strong anti-fungal prescription creme.

            I have literally not needed any antifungal treatment for about three years and now I am back to having to treat every few days.

            You know, I’ve sometimes rolled my eyes at all the alternative nutritional advice out there because it is so hard to sort out, and hard to evaluate as the impact is usually very slow and hard to know what to attribute success to. However, I have turned myself into a perfectly designed single subject experiment that proves the importance of these issues, at least in my case.

            I wonder if candida has been hiding in my system for all these year waiting for an opportunity or if I just completely changed my gut biota with all the fermented foods and poor low carb choices.

            As for how I originally gained back my health, we did many elimination diets and the only things that seemed to make a clear difference was with too many carbs I had immediate increased itching (that was the only eat white rice and chicken week!) Too many oxalates and I had bladder and vulvar pain so I kept my diet relatively low in carbs. I also went from once a week diflucan to twice a week diflucan, added an estrogen creme (i’m in menopause), added zantac, tried a bunch of other medications and suppliments that didn’t help at all…after several months of eating moderately low carb and all the above I still had low level symptoms although improved. Then we did one week on a strongly anti inflammatory antibiotic and within a couple days all pain was gone. I was tested many many times for every single bug that could be found “down there” and nothing significant was found but the antibiotic still worked.

            I wish I had the PHD to guide me back then as I believe I had inadequate nutrition overall with all the restrictions. However, it needs modification as sweet potatoes are out on a low oxalate diet and bone broths and fermented foods are out on low histamine.

            Also, I truly think the idea that there is an ideal level of carbs is right–under 100 gms a day and I get shaky and dizzy, too many and I start to get itchy and reactive.

            As far as ketosis, ketosis was a disaster for me so Paul is right on that one. If I could figure out how to eat about 80 gms a day without feeling dizzy and lightheaded all the time I think that is best for my system.

            Well, thanks for thinking of me, Natalie. I’m still having lots of yeast issues but thankfully I have lots of tools to use and I believe over time I’ll get back to health again.
          • Chris July 28, 2013 at 2:01 pm

            Hi Ann,

            I don’t know why there is no option to reply to your post down below so I post it here.

            What antibiotics did you take? I am considering a trial with antibiotics myself but pain isn’t my problem (fatigue, brainfog…).

            Thanks
            Chris
          • Natalie Campbell July 30, 2013 at 9:44 pm

            Dear Ann, The fact that an antibiotic helped makes me think of dysbiosis and sibo [small intestinal bacterial overgrowth. There is another set of restrictions called FODMAPS which can give you even less to eat! You can find interesting sites on these subjects.
            I had dysbiosis diagnosed by the Nutr’eval lab test by Genova. To treat it without antibiotics my alternative nurse recommended biocidin,a broad specrum antimicrobial botanical, interfase plus, to break down biofilm, and probiotics [I used Claire]. I went through 2 bottles of biocidin and interfase and was doing much better. The nurse says dysbiosis and sibo tend to come back so I should use the peoducts every 6 months indefinitely. The products can cause die-off so have to be intrduced very slowly. Best wishes, Natalie
29. Eddie Pena July 19, 2013 at 6:04 pm

    Hi Paul:

    What is your take on consuming a probiotic supplement and aloe vera at the same time/day)? I don’t eat very many fermented veggies.

    What are your thoughts on taking a ubiquinol supplement?

    Per the Omega-3 study, do you think there is harm in continuing Omega3 supplementation for my child of 7 years?

    Reply
30. frank July 20, 2013 at 1:19 pm

    hello paul,
    my rosacea didnt improve with your diet.after being in the sun my skin explodes, altthoug i use a sun protection creme(spf 50). how can i get enough sunlight for vit d without getting red by rosacea again
    frank

    Reply
31. marcus volke July 22, 2013 at 10:32 am

    Hi Paul, I was just reading your rebuttal to Dr.Rosedale’s critique on the PHD diet and was pretty blown away by what I read.

    Do studies really consistently show that high carb diets lower fasting glucose?
    And if so then why did you warn of the dangers of a high carbohydrate diet in your original PHD book, and use the association between high fasting glucose and higher mortality rates as a rational for restricting carbohydrates to 20-30% of total calories? Wouldn’t it make more sense to warn against very LC diets to keep your Fasting Glucose down?
    Furthermore, do LC diets also associated with higher HBA1C (glycated hemoglobin) levels? And do high carb diets then assocaited with lower HBA1C levels?

    Also, if low carb diets = higher faster glucose and higher fasting glucose = higher mortality rates, does that mean that low carb diets are significantly more dangerous than even VERY HIGH carb diets?

    YOu have totally turned my views on this subject upside down so I would really appreciate it if you have the time to elucidate this for me! Thanks.

    Reply
    • Paul Jaminet July 22, 2013 at 1:04 pm

      Hi Marcus,

      There is an optimum for everything. Too much carbohydrate increases fasting glucose in those with prediabetes or diabetes. Too little carbohydrate increases fasting glucose. You want to eat just the right amount of carbohydrate, about 30% of energy.

      Reply
      • marcus volke July 22, 2013 at 1:10 pm

        Ok, so in other words if you eat too many carbohydrates in the short term you will low fasting glucose, but in the long term you will become insulin resistant which will lead to elevated fasting glucose?

        Thanks for your reply!

        Reply
      • marcus volke July 22, 2013 at 1:12 pm

        Ok, so in other words if you eat too many carbohydrates in the short term you will have low fasting glucose, but in the long term you will become insulin resistant which will lead to elevated fasting glucose?

        Thanks for your reply!

        Reply
        • Paul Jaminet July 22, 2013 at 1:37 pm

          No. If you eat too many carbohydrates you will have low fasting glucose and high insulin sensitivity, unless you make yourself prediabetic or diabetic, in which case you will have high fasting glucose and insulin resistance. If you eat too few carbs, you will have insulin resistance and high (but not super high, around 100 mg/dl) fasting blood glucose.

          Reply
          • marcus volke July 26, 2013 at 10:21 am

            My understanding is that when cells are initially exposed to a chemical (in this case insulin) they grow longer and more (insulin) receptors initially, making them more sensitive – but with chronic over exposure to that chemical the receptors start to shrivel and die off.

            At least that’s what happens with addictive drugs, which is why drug addicts need increasingly higher doses to get the same effect. What do you think?
          • marcus volke July 26, 2013 at 11:11 pm

            TO clarify I meant that in the case of diabetes, short term exposure to insulin (from eating carbs) should cause more insulin receptors to grow and thus increase insulin sensitivity; but chronic over exposure to insulin will cause the cell receptors to shrink and die off leading to insulin resistance.
32. Rona Roberts July 22, 2013 at 2:10 pm

    Paul and Shou-Ching,
    I have now been following PHD for three months, after an earlier try that lasted a few weeks. I had already been gluten free for four years. I had not been eating resistant starch, and now I am. Some of the ways my health is improving, gradually: excellent increase in energy and stamina, less less Armour Thyroid for Hashimoto’s Thyroiditis than before (90mg to 30mg a day); better sleep, generally calmer and more optimistic, less gastric distress. Thank you for everything you have learned and shared.

    I work steadily to improve Circadian rhythm alignment, following a suggestion you made specifically to me some months ago, as well as follow the food suggestions, many (but not all) of the supplements, and I exercise daily with at least a 30 minute walk. These all seem positive changes for me.

    My first attempt at IF during PHD (after long low-carb and shorter Primal diets) didn’t work all that well. I liked it, but leaned on coffee in the morning, and had a hard time feeling full during the 8 hours of eating.

    I have nearly finished reading PHD for the second time, trying to piece together more solutions to my particular puzzle. I was startled to find this, having missed it the first time: “Pathogens known to suppress autophagy include herpes simplex virus type 1 (HSV-2), Epstein-Barr virus, and cytomegalovirus.” (p. 355) I have Chronic Active Epstein-Barr, diagnosed in 2009, and most recently tested in December 2012. I have tried to read the footnoted abstract associated with this passage in your book, but…all it did was make me even more grateful to you two for translating for us mortals what we need to know. 😀

    I have gained a little weight on PHD, and need to lose about 30 pounds, for all the usual reasons and in addition, ideally, to reduce lingering hypertension and escape from Losartan. I’ve been thinking of giving IF another try, since things are generally going in a good direction, and IF might help with weight. But does this finding re: Epstein-Barr mean IF would not result in autophagy in my case?

    What a long build-up to a short question! Thank you for any advice.

    Rona

    Reply
33. July July 22, 2013 at 5:46 pm

    Hi Paul,

    I’ve tried to ask for an answer about the regular use of Miso and PHD. I can’t find some evidence you discourage its use , but on the other way, do you recommend it as a source of fermented food ?

    Which recommandation can you give for staying “cool” and “safe” during thoe hot periods of the season time ? here in Europe, Temperatures are high. And I was wondering whether you could have special tips or recommendation to give about this subject ? Thanks for te incrdible work you develop all allong this blog/site. Thanks ! Best, July

    Reply
    • Paul Jaminet July 22, 2013 at 8:14 pm

      Miso is good. From the PHD perspective fermented rice miso is best, but even fermented soy miso is probably acceptable in moderation, as long as it is gluten-free. Fermentation helps remove toxins and the undigested protein quantity is not large.

      Staying cool – well, dress lightly, use fans if you lack air conditioning, drink cool drinks such as iced coffee, consider putting some water and epsom salt in a baking pan and standing in it with bare feet to cool yourself and pick up some nutrition through the skin. These are random ideas but a few of them will be implementable.

      Reply
34. John July 22, 2013 at 8:11 pm

    Hi Paul —

    I eat a lot of lettuce. Like 12-16 cups of chopped romaine daily, spread across two large salads. (I find I am hungry all the time, despite 2y+ of PHD’ing, and this is my preemptive attempt at quelling that. Or at least giving me more to chew.)

    It just struck me that maybe this is a poor idea, and that without thinking I am above the ‘Goldilocks’ amount of fiber (from “Location 3242 in the Kindle edition”). Certainly when I step back and look at (the size of) my salads I can recognize the potential for that.

    Do you think lettuce is significant enough to provide too much fiber? According to charts it should still only be 10-15g.

    thanks!

    Reply
35. July July 24, 2013 at 4:03 pm

    Hi Paul,

    Thanks so much for your tips to cool our body ! I’ve tried epsom foot bath ; tremendously efficient !

    I’ve read along on scientist french magazine that some recent studies mention cadmium toxicity in plant foods like potatoes, (Here, In France, potatoes are grown in very rich cadmium soil, and it seems potatoes can particularly concentrate cadmium in their tubers). It seems cadmium can especially be harmful for breast women’s health and for everybody’s health (kidney, liver ) Would you recommend to buy organic potatoes (it’s not cheap at all…)or to forget this new alert as our paleo ancestors were using those foods for so long with not so many harmful effects…?

    Best,
    July

    Reply
    • Paul Jaminet July 24, 2013 at 9:10 pm

      Hi July,

      Well, if it’s true your local potatoes are high in cadmium, I’d try to get potatoes produced somewhere far away.

      Organic potatoes would still have that problem, if they were grown in cadmium rich soil.

      I think it would probably be fine to eat some cadmium rich potatoes, as long as they weren’t a big part of the diet.

      Reply
      • July July 26, 2013 at 9:32 am

        Thanks Paul ! Clever tip ;).
        What would be the amount of potatoes you consider being “big part of the diet” ..?potatoes is our main source of carbs (my friend eats about 1.5kg per day. I do a little bit less…). Maybe there is a way to flush cadmium out of the body with some other food ?

        Thanks,

        Best,

        July

        Reply
36. frank July 25, 2013 at 4:17 pm

    Hello Paul,
    im on paleo since march 2013,on PHD since mid of april.After years of knee pain im happy to say that its complete gone.I lost 30 pounds and feel much healthier.But 2 problems are still there.
    1. my rosacea didnt improve
    2. my regular back pain did not go away( not a bone problem, my muscles become hard without reason)
    Am i just to unpatient?

    Reply
37. Adrian Ward July 25, 2013 at 8:43 pm

    ❓ Could you give some insights into how to clear gall/liver stones safely without resorting to gallbladder removal please?

    Reply
    • MachineGhost July 26, 2013 at 11:04 am

      http://www.amazon.com/gp/product/0984595449/

      Reply
      • MachineGhost July 26, 2013 at 11:08 am

        Cheaper, but older: http://www.amazon.com/gp/product/B003ODHONG/

        Reply
38. Ellen July 27, 2013 at 3:01 pm

    Hey everyone, I found a great cracker

    The name is ABSOLUTELY gluten free

    The ingredients are: tapioca starch, water, potato starch, potato flour, expeller pressed palm oil, natural vinegar, honey, egg yolks, salt, garlic flakes, caraway seeds, poppy seeds, sesame seeds

    The box I have is their “everything” variety, I assume their plain one would be the same without the seeds and garlic. There a very few of the seeds in the cracker so not a problem of eaten occasionally.

    Reply
    • erp July 27, 2013 at 4:59 pm

      What’s the name of them and where do you get them?

      Reply
      • Ellen July 27, 2013 at 6:20 pm

        The name is actually exactly what I wrote:

        ABSOLUTELY gluten free

        http://absolutelygf.com/

        It is confusing because the name sounds like description
        not a name. Got them at my local health food store

        Reply
39. Amelia July 27, 2013 at 8:12 pm

    I’ve been having Celiac symptom flare-ups recently, and for the first time in 4.5 years since diagnosis, these don’t appear to be in relation to consuming traces of gluten accidentally. I’ve been eating at home in our gluten-free kitchen, cooking our food from scratch as usual.

    I wonder if I still have intestinal permeability (apparently most Celiacs have very high zonulin even after a couple years on a gluten-free diet) and what specifically I can do to promote healing. Any advice on how to do that? (I searched the site but I could be missing a post or comments where that was covered.) Any other ideas?

    Reply
    • Amelia July 27, 2013 at 8:19 pm

      Oh, and to be more specific: my Celiac flare-ups are primarily joint pains that can be severe and go on for days. I’ve also been having headaches and been especially intolerant of being hungry – it makes me feel ill now.

      Reply
40. Meg July 27, 2013 at 10:25 pm

    Hello Paul,
    I loved reading your book. For once it felt as though somebody had approached researching nutrition the way I wanted to understand it. Forgive me if I ask a question that’s already been covered within the text/this website, however, I just wanted to ask a few things…
    I’m a 19 year old uni student (physio) and dancer. In the past 3 years, to keep my physique as necessary, I’ve been through <500/day, no sugar, grain free, paleo/primal, low carb high fat diets successively, but have never been able to achieve the easy maintenance I desire. I recently reached the point where I started eating meat and vegetables and little else. I feel as though every time I removed a food a tolerated other things less and less. Just prior to reading your book I started following the nutritional protocol set out by Dr Natasha Campbell-McBride in GAPS. I have had sub-clinical depression, some irritable bowel symptoms, etc. and decided I needed to "heal my gut".
    On that protocol I felt positive, but very very fatigued – obviously not ideal. I also couldn't recover from normal training sessions and have had DOMS for almost a week now. I'm up to the stage where I would be adding in almond butter/meal and olive oil, but on reading your book I'm not sure this is good for my health. Also, I feel like all the bone broth may be giving me excess amounts of something… Do you think it would be best to start eating starches again? Or continue on this protocol?
    Apologies, that was very long-winded. I'm just a little confused and scared! I just want to be able to maintain my body and stay healthy without having to try so hard – and your diet appears to have done that for a lot of people!
    Thank you for sharing all your knowledge and expertise, I really appreciate it!!

    Reply
41. John July 28, 2013 at 1:39 am

    Hi Paul,

    What are your thoughts on getting genetic testing done to identify possible gene mutations and other sorts of genetic defects/abnormalities (e.g. MTHFR expression)?

    Reading about getting methylation cycles working properly is extremely important for functions such as detoxification.

    Thanks, John H.

    Reply
    • Dora July 28, 2013 at 3:35 am

      Hi John,
      This morning I was wondering about the very same question. I hope that Paul will find the time to reply to it.
      Best wishes,

      Reply
    • Paul Jaminet July 28, 2013 at 3:20 pm

      Hi John,

      I think it’s a good idea for anyone who has health problems of mysterious origin, since tests like 23andme are so cheap ($99). It may suggest ways to personalize nutrition a bit. That said, I think the typical recommendations for those with MTHFR mutations are probably wrong, they probably just need more choline.

      Reply
      • John August 12, 2013 at 3:57 pm

        Thanks for the reply Paul.

        I would love to hear more of your thoughts on treating gene mutations such as MTHFR in a future post. Just an idea if you ever get more time to write.

        Thanks again. God bless.

        John

        Reply
      • Darrin August 13, 2013 at 12:31 am

        i would love to hear more thoughts on methylation as well.

        esp undermethylation, as i think this may apply to me.

        would be good to know what foods/nutrients to avoid & which to eat/take.

        i was reading that undermethylators do better avoiding choline and making sure they get ‘plenty’ of inositol…

        Reply
42. david05 July 29, 2013 at 6:24 am

    Hi Paul,
    I was trying to adopt the diet an dthe supplements but wondering if you can help on this issue: i’ll start with the questions and then explain.

    A. Is it wise to take B-vitamins while still having gut infections like bacterial yeast or parasites?
    B. Many of B-products are made from yeast or grains – or is it a different kind of yeast – some said “inactivated yeast” other brewer yeast. Would that be a problem while having candida?

    I’m facing multiple gut infections (parasites, candida, bacterial) and adrenal fatigue. Some people with candida or AF do take a vit.B supplements and report no problem. I’ve read B vitamins are very usefull for adrenal fatigue – not healing but good support, detox, mood etc. I want to have some to reduce the weakness and so on BUT Searching more for an answer I found that some pathogens feeds on B vitamins – but I’m not sure if they are just feeding or are strenghetn by B vitamins …meaning harder to eradicate with B vitamins supplied…hm…one example. http://en.wikipedia.org/wiki/Giardia_lamblia –
    When I took bread out i’m very weak and it seems starch at this point doesnt make any benefit for me.

    Many thanks for your thoughts
    Dave

    Reply
43. david05 July 29, 2013 at 6:31 am

    Hi Paul,
    I was wondering if you can help with this issue: i’ll start with the questions and then explain.

    A. Is it wise to take B-vitamins while still having gut infections like bacterial yeast or parasites?
    B. Many of B-products are made from yeast or grains – or is it a different kind of yeast – some said “inactivated yeast” other brewer yeast. Would that be a problem while having candida?

    I’m facing multiple gut infections (parasites, candida, bacterial) and adrenal fatigue. Some people with candida or AF do take a vit.B supplements and report no problem. I’ve read B vitamins are very usefull for adrenal fatigue – not healing but good support, detox, mood etc. I want to have some to reduce the weakness and so on BUT Searching more for an answer I found that some pathogens feeds on B vitamins – but I’m not sure if they are just feeding or are strenghetn by B vitamins …meaning harder to eradicate with B vitamins supplied…hm…one example. http://en.wikipedia.org/wiki/Giardia_lamblia –
    Many thanks for your thoughts,
    Dave

    See more at: http://perfecthealthdiet.com/recommended-supplements/#sthash.gfqohGH7.dpuf

    Reply
44. Gareth July 29, 2013 at 5:57 pm

    Hi Paul,

    Quick question regarding alcohol consumption. Being young I tend to go out quite a lot and end up drinking fair amounts of alcohol on the weekends, is there any way to mitigate most of the damage that it will do. I have recently read the

    http://highbrowpaleo.com/2011/12/26/the-highbrow-paleo-guide-to-binge-drinking-mitigating-the-deleterious-effects-of-ethanol-on-health-or-how-to-get-shitfaced-with-impunity/

    and began taking Pantethine and of course I limit the intake of omega 6 as much as possible.

    is there anything else that could help? I am already following the PHD diet.

    Thanks!

    Reply
    • George @ the High Fat Hep C Diet July 30, 2013 at 3:41 am

      NAC is very protective against hangover and subjective toxicity of alcohol, also protects liver. SAMe, l-methionine, l-cysteine, taurine are all effective substitutes.

      Reply
      • George @ the High Fat Hep C Diet July 30, 2013 at 3:44 am

        Also glutathione.

        Reply
      • Donna July 30, 2013 at 12:17 pm

        Dr. Mercola (mercola.com) has stated that NAC is not a good supplement to take if you have amalgam (mercury containing) dental fillings. Evidently it facilitates mercury entering the brain. Perhaps Paul could comment?

        Reply
        • Darrin July 30, 2013 at 11:34 pm

          hi Donna,

          do you have the link handy to the Mercola post that mentions NAC

          Reply
          • Donna July 30, 2013 at 11:59 pm

            Hi Darrin. If you google mercola.com and enter NAC amalgam fillings in his search window you will see the bit he says about it. Basically, “I advise against using NAC if you still have mercury amalgam fillings because it could interfere with the detoxification of the mercury.” I’m not sure if it was Mercola or perhaps Dr. Blaylock (Excitoxins is his book) that makes note of its (mercury’s) affect on the brain being greater if NAC is taken regularly if one still has amalgam fillings. I can’t find any other references about it when I search. I’m hoping Paul will comment…..
          • George @ the High Fat Hep C Diet August 2, 2013 at 5:26 am

            NAC apparently makes it easier for mercury to move around the body. But there are other things you can do to increase its excretion; spirulina and chlorella do speed up detoxification of heavy metals somewhat by inhibiting reabsorption, and selenium is specific for neutralising mercury.
            However this all relates to mercury in your circulation; NAC, etc. will not make the mercury leave your fillings any faster.
            Unless you have clinical mercury toxicity the NAC effect, if any, is unlikely to be significant. If it is just a concern about a few fillings still in the teeth, it wouldn’t stop me using NAC.
          • Donna August 2, 2013 at 11:12 am

            Hi George, Thanks for this interesting info. I do take chlorella and BG algae. Have you watched ‘smoking teeth’ on uTube (my biological dentist told me about this video). I had concerns as it looks the the amount of mercury released from almalgams (with just ordinary eating and drinking) is significant.
          • George @ the High Fat Hep C Diet August 3, 2013 at 12:22 am

            All my many amalgam fillings fell out and got swallowed when my teeth decayed 10 years ago. And I survived, even taking NAC for some years after that. Maybe some mercury is still there and accounts for some things from time to time, maybe not.
45. Darrin July 29, 2013 at 11:05 pm

    Hi Paul……Lithium protocol query/advice,

    I am going to give the Lithium supplement a trial to see if it helps fix my insomnia (sleep maintenance) & helps correct my suspect cortisol rhythm.

    I have held off till now because i do have slight hypothyroid symptoms (cold extremities, low body temp).
    But i have changed my focus to fixing my sleep, hence the lithium trial. i think fixing my sleep will fix my cortisol rhythm, or vice versus (chicken/egg).

    so i have ordered the lithium tablets you suggest.
    & will cut in half for 2.5mg.
    Can you offer any more details/suggestions re the ‘lithium protocol’?
    – any particular time in the morning?
    – how long should i give the trial to fully test?
    – any adjustments/additions/subtractions to other supp recs (selenium, iodine, other….), doses, timings,…?
    – ?

    more info:
    my TSH is sub-clinical high, recently ranging between 2.5 & 3.5, ft3 & ft4 are within ranges. rt3 tested high a while back, most likely due to high cortisol.
    I was probably on the low side of your starch recs when these tests were done. I have since increased my safe starch intake to more than meet PHD. So it is possible these lab numbers may have improved, but i am going off symptoms at the moment.

    I will let you know how the trial goes, positively i hope.

    Reply
    • Darrin August 1, 2013 at 7:27 pm

      sorry to bug Paul,

      my lithium tabs will arrive today.
      so it would be good if you get a chance to respond to my queries above…
      if not i seem to recall you mentioning to take lithium in the late morning,
      so i will start by taking around 11am.

      two more Q’s to the list,
      – should lithium be taken between or with meals (i will check the label).

      – would there be any benefit of starting at a 1/4 tablet (1.25mg lithium). if so, for how long (before going to 2.5mg).

      many thanks

      Reply
      • Paul Jaminet August 1, 2013 at 10:28 pm

        Hi Darrin,

        11 am is good. You can take it fasting. There’s nothing wrong with taking a quarter tablet, but a half tablet is a pretty low dose and shouldn’t do you any harm. If you clearly notice the effect of half a tablet, you could try cutting down to a quarter. You can also experiment with a whole tablet.

        Reply
        • Darrin August 1, 2013 at 11:52 pm

          Thanks for the reply Paul,

          & if you get a chance to comment again…

          will supping lithium ‘change things up’ straight away ie. should i notice a change in my sleep or circadian rhythm straight away/over a few days,

          …or is it more a longer term thing where things will slowly change over weeks/months.
          as my ‘lithium stores’ (?if such a thing exists) increase.

          Reply
46. Carol July 30, 2013 at 10:54 pm

    Gluten Free Gochujang?

    Has anybody tried this recipe, or one like it? All the commercial Gochujang I have seen has wheat in it, so this recipe is tempting!

    http://blog.ideasinfood.com/ideas_in_food/2013/02/gluten-free-gochujang.html

    Reply
47. David Andrews August 1, 2013 at 9:06 am

    Does anyone know of a test specifically directed at aspirin sensitivity? That is, some people benefit from from taking a small amount of aspirin every day, but others do not. Is there a test that determines whether you may benefit?

    And I recall that there was a recommendation for a particular lab to get blood tests performed. What was it?

    Reply
48. Dora August 1, 2013 at 5:10 pm

    Hello,
    I am not sure if this has been already covered.
    I wonder if eating carbohydrates and proteins at different times will not diminish the benefits of the PHD?
    I seem to enjoy having rice (potatoes) with vegetables for lunch and meat (fish) with vegetables for dinner.

    Reply
49. Simona August 2, 2013 at 6:48 am

    Paul,

    I started a PHD style diet about 2 weeks ago, a weight loss one as per your posts (cutting fat because I’m rather sedentary) in the hope that a nutrient rich diet will help me lose fat over time. (major change was cutting excess chocolate, which means less fat and sugar) I’m trying to eat the necessary carbs, although I don’t always manage, I think. My cortisol regulation is poor, can’t go to sleep at night so I don’t want to do IF. I only supplement Mg 400 for constipation, a few times a week, multiBs once a week and sometimes vit C. I feel extremely tired, I even find it hard going upstairs, my breathing is not great either. I need to lie down in the afternoon and don’t feel like exercising. It seems my body is saving energy but my pulse is sometimes elevated.
    Besides making sure I’m getting the 600 kcal of prot+carb is there anything I can do? I do eat an egg a day. (I should make sure I eat bone broths, liver once a week?)
    It might be something else.
    Thank you.

    Reply
    • Ellen August 2, 2013 at 8:20 am

      How is your blood pressure? Have you had a complete check up lately?

      the recommendation here is for three egg yolks per day. You can eat the whites too if you want, but it is the yolks that have the choline that is so necessary.

      Have you tried just walking for exercise? Perhaps a little three times a day to get the circadian rhythms entrained? And Perhaps try the whole supplement regimen as laid out

      Quite honestly unless you have given everything Paul recommends a good try for at least a few months, it is hard to see how he can offer much advice, brilliant though he is.

      Reply
    • MachineGhost August 2, 2013 at 10:25 am

      It sounds to me like you’re hypothyroid which seems to go along with insufficient carbs and cortisol stress. Maybe even anemic.

      Remember, your brain alone needs 130g of net carbs a day! So you ideally want 130g of net carbs + 75g of protein per day. If you eat less net carbs than 130-150g, you must up the protein well above 75g to compensate as it is very inefficient source of energy.

      Reply
50. Ann August 2, 2013 at 11:41 am

    Hi,
    I am treating myself for sibo since a positive breath test. I am taking interfase plus 30 min. Before the herbal antimicrobials, drinking cats claw tea and trying to eat low fiber, sugar and fermentation potential including low fodmaps. I dont tolerate any starches but jasmine rice which i can eat about 1.5 cups of cooked rice per day, usually in a soup. I am trying to eat more fat as i have lost a few pounds. My question is, am i at risk of a glucose deficiency if i keep upmthis protocol for another 2-3 weeks? and if so is there another source that can be absorbed quickly and not aggravate sibo? My eyes have been itchy lately and i have had leg cramps again similar to when i was low carb.
    Thanks,
    Ann

    Reply
    • Natalie Campbell August 4, 2013 at 9:19 pm

      Dear Ann, Good for you! I definitely think sibo is related to interstitial cystitis. I know this isn’t PHD but I eat oats because I have so few foods on the PHD. However squash is OK and will give you some starch. {especially acorn and butternut squash.]
      If I ever get all this figured out I’ll let you know! Just reread your post. Did you look at all the different categories of FODMAPS? Most people react to some but not all. For example I do the worst with polyols and fructans but not too bad with fructose. For help in sorting through the FODMAPS try Patsy Catsos’ website. Natalie

      Reply
    • Wout August 10, 2013 at 12:17 pm

      Hi Ann,

      you might consider rice syrup (dextrose) as a source of glucose. It doesn’t contain any fructose and it is the most available form of glucose, so hopefully you can absorb it all before the bacteria in your small intestine get to it.

      See also Pauls answers at http://perfecthealthdiet.com/2010/07/bowel-disease-part-ii-healing-the-gut-by-eliminating-food-toxins/comment-page-2/#comment-63860 , http://perfecthealthdiet.com/2010/07/bowel-disease-part-iii-healing-through-nutrition/comment-page-2/#comment-107064 and http://perfecthealthdiet.com/2010/07/bowel-disease-part-iii-healing-through-nutrition/comment-page-2/#comment-109013
      and Ray Medina’s comment: http://perfecthealthdiet.com/2012/09/do-the-elderly-need-paleo-more-than-the-young/comment-page-1/#comment-90754

      Cramps might also point to a deficiency in e.g. magnesium.

      Reply

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