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)

Paul,

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,

A

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?

G

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.

Lupus

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

Depression


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 ?

10,151 Comments.

  1. Hello,

    This is a question for everyone. I’m looking for a good recipe for mayonnaise. When I make it with olive oil the flavor balance is off. Does anyone have any ideas? A more neutral oil? Avocado oil maybe? Seems like mayonnaise would be a great PHD food with its egg yolks and lemon juice. Thanks!

    • Perhaps a different olive oil might help – there are many different variations in flavor of olive oil – but here is a recipe I really like (you need to mix it with an electric mixer to blend it into the right consistency):
      Put 2 egg yolks in bowl with 1 teaspoon salt, 1 or 2 teasp apple cider vinegar or white vinegar, and juice of half a lemon. Whisk well.
      Gradually add 200 milliliters of olive oil in a thin steady stream, whisking all the time.
      Taste and adjust to taste with salt, pepper, more lemon juice, and, if you like, herbs (finely chopped dill or 1 teasp Dijon mustard).
      As a variation, add 2 small cloves of crushed garlic to the egg yolks before you start whisking.
      M

    • This Mayo available retail is a formulation by Dr. Mary Enig a co-founder of the Weston A. Price Foundation.

      http://www.wildernessfamilynaturals.com/product/dressings-condiments-mayo/Mayo16.php

      Mary Enig’s Triple Oil Blend
      This wonderful blend of three oils can be used in salad dressings or as a cooking oil. This oil blend contains an equal balance of Omega 3, 6, and 9. When used for cooking, flavors come through beautifully, and the blend does not burn as easily as pure coconut oil. In salads, it provides all the benefits of coconut oil and does not have the strong taste of olive oil. In mayonnaise, it provides firmness when chilled.
      Recipe Type: Condiments and Sauces
      Yields: serves many
      Prep time: 10 min

      Ingredients:
      1/3 melted virgin cold pressed coconut oil*
      1/3 good-quality extra virgin olive oil
      1/3 unrefined sesame oil**
      * Melt the coconut oil at a low heat. Once the melted coconut oil is mixed with the other oils, it stays liquid in cooler weather.
      ** Expeller pressed or cold pressed sesame oil. Also untoasted.
      Directions:Place melted coconut oil, olive oil, and sesame oil in a jar of your choice. Shake well to blend.Cover tightly and store at room temperature.

    • Nick, I’ve made this recipe with avocado oil and enjoyed it a great deal. http://nomnompaleo.com/post/3440774534/paleo-mayonnaise

    • Thank you all so much for the recommendations!

      • I had already posted my version of mayonnaise on another page at this site. (Sorry! Can’t remember where it is now.) I make mine with macadamia nut oil because I agree that the olive oil is a bit too harsh. I’ve also found that adding a bit of sour cream with garlic and onion (to your taste preference) already mixed in helps too! I cheated on that part by adding dried onion and garlic flakes and I added that to the sour cream and let it sit overnight before using it in the mayo recipe, but you could use the real thing too. Just use a very small amount of each if it’s raw because they are stronger than the dried version.

        I’ve also heard about, but not tried, adding a small amount of paprika.

        I admit t’s still not perfect, but it’s better than before, and I am getting kinda used to it. I welcome any new ideas. I miss Hellman’s but not enough to go back to it!

  2. Are MCT and avocado oils safe to cook with / heat? I have read you shouldn’t heat olive oil.

    • Donna,
      I can’t speak for avocado oil, but MCT should not be cooked because it destroys the benefits of it. I only use straight up coconut oil, butter, or bacon fat to cook in.

      • Do you know if MCT is a ‘dangerous’ oil to heat i.e. AGEs produced? or just no benefits if heated? Does coconut oil retain its benefits when heated (I know it [and butter] are heat tolerant oil in terms of no AGEs).

  3. Hi Paul,

    I have the problem that frequently I am overeating. Especially right after meals I get even more cravings or being more hungry than before whether I follow PHD or not. How can I treat this, my digestion is already disturbed because of this overeating? Thanks.

    Chris
    BTW Not sure if there is any relation, but I never gain weight and I am a skinny type.

  4. Having trouble posting this is a test

  5. Hi Paul, I have some histamine intolerance;

    Every time I eat anything fermented – kraut, kombucha, kefir, etc- I get hives and brain fog.

    I also have problem eating fish, uncooked eggs and nightshades (which all produce histamine).

    The PHD is really high in histamines and I would like to know what diet you would recommend me to follow.

  6. Hi Paul.

    I recently got some bloodtests done as well as a cortisol saliva test. My cortisol was high from 8am-8pm (12 hour test). I have no trouble falling asleep (10pm), I wake up a few times during the night and then roll over and fall back to sleep, I wake up in the morning feeling totally unrefreshed – it takes 30-60mins to feel OK. I am 6’2″ and thin (72kg).

    My doctor thinks I have adrenal fatigue issues and has recommended some adaptogenic herbs as well as some brain calming supp’s like L-Theanine and GABA.

    Do you have any thoughts on what can help me reduce my cortisol levels and heal my adrenals apart from standard PHD, stress-reduction, circadium rhythm optimization, etc?

    I’m not sure what you think of this but Dr. Kruse believes that “adrenal fatigue is a brain injury at the hypothalamus all caused by bad signaling”.. he believes leptin, PVN, etc. are involved (http://www.jackkruse.com/brain-gut-16-adrenal-fatigue-rx/)

    Any thoughts, insights, recommendations?

    Thanks Paul

    Rick

    • Hi Rick,

      I would focus on circadian rhythm entrainment, intermittent fasting but don’t restrict calories or carbs, make sure you get enough salt and potassium-rich vegetables (eg tomatoes), get some extra carbs before bed eg honey. Magnesium can help, but all of our supplemental foods and nutrients should help. Improve gut immunity with liver, vitamin D, collagen-rich stews and soups, and vitamin C.

      Also totally darken your bedroom and make sure the sound environment is quiet (or brown noise like a rainstorm). Go to sleep at a regular time.

      I don’t object to the theanine and GABA but you may find they are unnecessary.

      Best, Paul

      • Hi Paul, I do IF for pathogens (big problem) and also have sleep problems for which I see you say extra carbs like honey before bed. How would I incorporate these two things? Thanks, Donna

  7. Hi Paul,
    I am a new reader of your book, moving in this direction, making bone broth–I’ve read Weston Price, Mary Enig, etc.
    I have a family history of circadian rhythm disorder. Interestingly, there is also bipolar family history. I saw the references to circadian rhythm and bipolar disorder having some commonalities. I wonder if lithium could help me regulate my circadian rhythm disorder? Why is it on your list of supplements for some people?
    I take Vit. D in the morning, melatonin at bedtime, have the computer light altered by f.lux. I’ve been up late all my life, and I had breast cancer, very low Vit D levels. It has been virtually impossible to reset my lifecycle clock in any lasting way. Since I get up so late (noon or later) if I then fast a few more hours, my eating rhythm is into the dark hours…
    (I also have extreme sensitivity to light, sound, odors, vitamins, medications of any kind-usually stop taking them. So, I need to prioritize the most important changes, incrementally.) Any suggestions?
    I appreciate your holistic approach to diet and health!
    Em

  8. Paul,
    I notice that you recommend 3 egg yolks per day.
    How do you take them? Raw? Slightly cooked in shell? Do you discard the white entirely?

    Mercola used to recommend the opposite – eat the whites uncooked and discard the yolk.

  9. Diagnosed with gastritis last Monday after nearly two years on PHD diet. 🙁 Doc checked me for H. Pylori and that is negative, thank heavens. 🙂 Still, what’s going on here? Can anyone give me an idea? Thought that PHD was going to heal my gut, not put me into gastritis! ❗ Doc put me on Omeprazole DR 20 mg 2x a day for a week, then 1x a day after that for the next month and a half. Any insight would be appreciated, as the research I have done seems to point to a high fiber, bland type diet being a better pick for this problem. 😕

    • Hi Mary,

      I’ve been on Prevacid (a PPI) for almost two years now. When I started PHD three weeks ago, I started skipping this med for a few days at a time. At first, I felt great and didn’t even need it. Then as the days went on the heartburn began coming back. So, I still take it about 3 days a week at this point. On days that the heartburn was really bad, I skipped a few meals. That’s when I realized intermittent fasting helps greatly! Also, reducing acidy foods like tomatoes and fruit helps as well. I still have to eat small meals and not overload my stomach with anything, even water or else the heartburn comes back slightly, although not nearly as bad as before I started this diet. Before, if I went over 24 hours without my medicine, I would have horrible gnawing reflux pain. So it has improved but I’m still not completely off the medicine yet. That is my goal. PPI’s are bad news because they lead to vitamin and mineral deficiencies which lead to diseases. So, good luck to you. Try to eliminate the offending foods/drinks first before giving in and taking Omeprazole. I hope someone else
      who’s been on the diet longer would have some insights to share with you (and me too!)

      • I also struggled with gastritis/oeophagitis/reflux for years. Long story short,(besides now doing PHD with IF), I eliminated food sensitivities (food with mold was a particular trigger [many cheeses, soy sauce, vinegar, raw grapes, strawberries, cantelope), I take a huge dose of probiotics (Mercola’s) because a test showed zero lactobacillus in my gut even on a probiotic supplement and eating yogurt; and I take digestive enzymes (Mercola’s) daily. Now for any minor symptoms, I use DGL (deglycerized licorice extract) and slippery elm lozenges which are very soothing. Off stomach Rx meds (had been on for years) and no findings on my last endoscopy.

        • Hi Donna,

          One more question: How did you get tested for food sensitivities? I’ve conflicting things and want to know from someone who’s had it done.

          • An allergist (now passed) did a skin test. My MD and ND had told me that he often detected reactions/sensitivities that other allergists did not, and they trusted his results. When he retested over the years, some had stopped reacting but others (like mold – my worst) persisted.(my blood tests have always been completely negative, by the way.) On recent repeat skin testing (new allergist) he found nothing – not even any reaction to the test patch which everyone should react to; but he still did not think it was a ‘false negative’ test (which did not seem logical to me). He expressed some skepticism about how my original MD had tested with no details about why he doubted him. (btw, when I adhered to the original dietary restrictions, big improvement in GI and joint pain within 2 weeks, with continuing improvement over time; & testing/re-introducing foods increased symptoms). I think the lack of test findings is fairly common from talking to friends. If that is the case, I think an elimination diet is the only way to be sure that the tests are not false negatives.

    • Mary,

      Have you been eating a lot of coconut oil? Have you been doing the ketogenic version of PHD. Do you have any evidence of fungal infection? Even just a fundal toenail?

      Those things caused me to have acid reflux. Paul explained that while ketosis can be very helpful in many conditions (If you have an underlying fungal condition), it will feed fungus.

      • Hi Donna,

        Can I take the licorice or the slippery elm for mild stomach discomfort? This is the first I heard of this and am curious.

        • Yes, mild or even more severe; or even, for example, prophylactically / daily / a couple hours after dinner. If I eat some slightly spicey food, I take it about 2 hours after I eat. I order it from Vitacost.com I also take Peptobismal when I travel for its antipathogen properties. I used to use Organika antacids occasionally, but no longer need them.

        • Yes, mild or even more severe; or even, for example, prophylactically / daily / a couple hours after dinner. If I eat some slightly spicey food, I take it about 2 hours after I eat. I order it from Vitacost.com I also take Peptobismal when I travel for its antipathogen properties. I used to use Organika antacids occasionally, but no longer need them.Other soothing things are raw apple, honey & vegetable glycerin in warm water; sometimes just very warm water.

  10. Hi Paul,
    I have been 90% PHD compliant for 10 months now (not enough bone broths,non-intense circadian rhythm entrainment,and eating a bit of sugary chocolate, honey and dried fruit are my shortfalls). I love the diet, but am failing to get improvement in any of my health issues, all of which mystify doctors. Hoping you may have an opinion.
    I have had constipation-dominant IBS for over 15 years, which i only learnt to manage in the last few years. It requires me taking psyllium husk (Metamucil) daily, and drinking a hot liquid in a squatting position in a quiet room upon waking. Magnesium supplementation has made no difference.

    Over the last 3 years i also began to experience extreme allergies in the grass pollen season, and minor dust mite allergies year round. These lead to throat swelling (apparently unheard of as a hayfever symptom) that means i cant talk more than an hour or so a day, and quietly, or i lose my voice. I also have shortness of breath, intermittent sinus pain, dizziness and frequent severe headaches. One of the strangest symptoms is that if i drink even quarter serving of any kind of alcohol during the allergy season (october to march where i live), i get a full blown headache within half an hour than lasts for about 5 days, gradually dissipating to become a feeling like tender bruising all over my scalp, neck and shoulders. (obviously, i have stopped drinking,but I do test it occasionally as part of trying to figure out what’s going on). Even outside of the pollen season i seem to have become very sensitive to alcohol.
    I underwent allergy ‘densensitization’ over autumn and winter this year. But instead of getting rid of my reaction, the injections replicated my symptoms for the whole course of treatment, which is apparently very unusual.
    I have done hundreds of hours of research at this point, made every lifestyle modification i can find, spent all my savings on medical care, been put on countless medications,(and weaned myself off of every one not long after, as they all seem to have horrible side effects, had to quit my job, and i still don’t know exactly what is going on.
    i have always kept very fit, and I used to be very robust, even with my IBS, and now i feel like my whole whole system is incredibly sensitive to every input or lack of input.I am 35.
    Any perspectives or suggestions would be graetly appreciated.
    Annie

    • Hi Annie, sorry to hear all that, how frustrating. have the doctors considered endometriosis? This can sometimes be misdiagnosed as IBS & it can cause constipation along with a range of other symptoms that can seem mysterious.
      M

    • Hi Annie,
      Have you looked into histamine intolerances? There is a long list of foods
      That can cause trouble for people, and alcohol is high on the list. Histamine problems, aka, mast cell issues are not often treated or even thought of here in the states. In the UK it is well known. I found that I cannot handle the bone broths or gelatin..I get hives and stomach upsets…I’m now keeping a diary of the foods I eat.
      Sandy

    • Hi annie,

      Sorry to hear of your troubles.

      This is just a guess, but I would think there’s a good chance you have some unconventional (non-bacterial) infection, such as a fungal infection. You may have high levels of circulating toxins eg cell wall components which deplete your toxin management system and make you sensitive to environmental toxins. I’m guessing you took antibiotics at some point which may have depleted beneficial bacteria and worsened the problem. Have you ever had a stool test?

      Make sure your diet has adequate vitamin A (liver weekly + sweet potatoes, spinach, carrots, persimmons, maybe up to 30,000 IU/week preformed A in supplements or cod liver oil), vitamin D is optimized, get vitamin C powder and mix it with water to a pleasant flavor and drink that to bowel tolerance, supplement 225 mcg/day iodine, 100 mg/week zinc, and N-acetylcysteine 1 g per day.

      There might be nutrient, esp trace mineral, issues too so be sure to eat seaweed and use sea salt and eat a nutrient-dense whole foods diet.

      I don’t know what the problem is but these are the things I would try first.

    • Annie, I have experienced several of your symptoms as well–severe grass allergy to the point I could hardly function. Had allergy shots for a year and by the end of the year my arm started swelling up so badly that my doctor made me stop them immediately. I also can not tolerate even a tiny bit of alcohol, but especially red wine. Even a few sips and I feel awful, really sick, dizzy and out of it. Have severe constipation (but for me 600 mg of magnesium works great if I don’t miss a day.) On top of it, I have interstitial cystitis and vulvodynia/vaginal yeast infections where even the normal amounts of yeast in the vagina cause severe itching and pain. Although many of us have both similar and different issues the underlying inflammation and over hyped up immune systems seem to underlie it all.

      The good news is that I have had many years of complete recovery where I feel totally healthy. The bad news is that if I mess up with poor diet/stress/lack of exercise/etc I can have an abrupt and disabling flair up. It is rather scary how quickly yeast can overtake me, its like I go over a trigger point and it all cascades into a big mess of pain/itching/severe constipation, exhaustion and general malaise.

      The best guess I have is that I’ve got an overactive histamine system as well as too much inflammation. I have to pay more attention to my health and wellness than maybe others do.

      The stress and depression that goes with a chronic disease process that doctors can’t figure out is epic, you really have to work equally hard at keeping your mind and spirits in as happy and relaxed place as you can possibly manage because cortisol and stress hormones will never let you heal if they are constantly flooding your system. How you do that is hard to know when you are so desperate, but I believe HOPE is the small flame you need to fan. Paul has given you some things you can do and doing something positive for yourself is very empowering. Paul doesn’t address histamine much but you should read up on that as well.
      Take care,
      Ann C.

      • P.S. You should probably follow Paul’s advice one step at a time, as I know I can not tolerate any Vit C, especially when I am in a flair. It really does a number on my bladder. You might have strange reactions to some common vitamin/mineral as well, you don’t want to make yourself sicker and not know what is causing it.

        • Paul , I am struggling with interstitial cystitis that I believe is related to candida yeast. It came on abruptly after a 2 month long battle with a yeast infection. After taking diflucan, it seemed to go to my bladder. I have been on a strict diet with very low carbs but it doesn’t seem to be helping . I just recently got your book and have added back sweet potatoes and rice. I make and consume fermented veggies daily plus coconut milk, coconut oil, grass-fed butter, grass-fed beef, chicken, fish etc. I also have adrenal problems and been on low dose cortef for 6 years because I got such severe insomnia. I am wondering if you are aware of a connection with interstitial cystitis and candida? I feel like I need to extra carbs but don’t want to feed the yeast. Appreciate any help or thoughts you can give. Thanks, Jen

          • Hi Joy,

            You should definitely eat more carbs, aim for 30% of calories from carbs – they’re needed for immunity to Candida and you will get systemic candidiasis if you go too low carb. Also support immune function with zinc, iodine, vitamin A, vitamin D, vitamin C, circadian rhythm entrainment.

            I think you should follow the general advice in our book as most of the systems you describe can be effects of being too low carb, or malnourished in some respect or other.

  11. Thanks all for your thoughtful responses. Sandy,I had looked into histmaine intolerance, but since I haven’t noticed any symptom correlation with histamine-rich foods (apart from alcohol), I haven’t pursued it further. I’d be a shame to have avoid them, since they include most fermented foods, (which because of my gut problems, i have been making lots of for years now). Paul, I did take several courses of antibiotics about a decade back, and yes i had stool tests when Dr.s were first diagnosing my IBS. I don’t imagine they were of the kind that would diagnose an ‘unconventional fungal infection’ though. Where would i get such a test? My training is as a horticlturalist, and I grow most of my own fruit and vegetables (organically), so i am actually eating carrots in every possible form at the moment to try and get through my latest crop! I eat a good bit of seaweed and liver weekly already, but I will try your other suplementation suggestions.
    Anne C, thanks particularly for your acknowledgement of the emotional side of chronic poor health. I feel like i deal with it pretty well via laughter and focusing on the gorgeousness of the world rather than my own limitations, but i the stress is still present enough than whenever i read words like yours i burst into tears. I have never had thrush, but i’m curious what form of magnesium you have had success with?

    Annie

    • Annie, the only magnesium that wasn’t good for me was magnesium citrate which must be closely enough related to citric acid to make my bladder pain act up. I’ve used magnesium malate and glycinate mostly.
      I found that using just magnesium and not adding the fiber works best. When I was totally constipated, I used 800 mg for a few days until I had daily soft bowel movements, then I moved down to 600. I take it around dinner time and then get up an hour and a half before I need to leave for work so I have time to have a hot drink and wait for the urge to come upon me. (Ha ha, don’t you love the internet where two strangers can talk openly about bowel movements. :))

  12. Hi Paul, anything you can suggest for tissue healing after hand surgery? Like Vit C and collagen protein maybe?

    • I went for intravenous vitamin therapy before and after some major dental surgery. Minimal pain (I didn’t take their boatload of recommended antiinflammatories and corticosteroids), zero swelling, and the stitches came out in 2 weeks instead of 4. The dentist couldn’t believe it.

    • Yes, those are the top two. Extra silicon — seaweed is a good source — and boron. For bone healing, vitamins A, D, and K2. Magnesium.

      • hi paul, i am going to have a hip replacement, are there any pre and post operation suggestions you might have .
        thks alfred

        • Alfred,
          Along withe the things mentioned by Paul and Stoll, I would highly recommend homeopathic arnica

          Take few of the 30 c three times a day the day before…away from food. Let dissolve under tongue

          As soon before surgery as possible take a few 200 c. Then a few more 200 c as soon after surgery. After that take 200 c only when you feel you are not continuing to improve , that may be hrs to tell, but more is not better.

          Homeopathy can seem woo woo, but Arnica is amazing when taken appropriately. And soon enough. I could tell you quite a few stories…………

          Hope your hip replacement goes as well as mine. Couldn’t ask for better.

          • thks Ellen, i will look into that

          • I second the suggestion to use homeopathic arnica both before & after surgery of any kind or degree. No one was more skeptical about homeopathy than my husband and myself but we’ve been astounded at how well arnica works. We use it ourselves as do many family members.

            Like Ellen, I have quite a few stories I could tell about how well arnica works. Any health food store carries both forms.

            For planned trauma (surgery, any type) use the pellets that Ellen mentions both before and after surgery (for at least a few days).

            For impact injuries, if skin is not broken, we use both the topical arnica gels or creams as well as the internal form (pellets) especially if the injury is a bad one. The topical arnica gels will accelerate the healing process, immediately reducing inflammation.

            Arnica works so well that not only do I keep supplies of both forms at home, in my office but i also bring them as a small first aid kit when traveling.

          • I second the suggestion to use homeopathic arnica both before & after surgery of any kind or degree. No one was more skeptical about homeopathy than my husband and I but we’ve been astounded at how well arnica works. We use it ourselves as do many family members.

            Like Ellen, I have quite a few stories I could tell about how well arnica works. Any health food store carries both forms.

            For planned trauma (surgery, any type) use the pellets that Ellen mentions both before and after surgery (for at least a few days), minimum 30 minutes away from food.

            For impact injuries, if skin is not broken, we use both the topical arnica gels or creams as well as the internal form (pellets) especially if the injury is a bad one. The topical arnica gels will immediateliy reduce inflammation and accelerate the healing process.

            Arnica works so well that not only do I keep supplies of both forms at home, in my office but i also bring them as a small first aid kit when traveling.

  13. Hi Paul,

    when I cook with coconut milk I get an inflammatory response with intense malaise and joint and muscle pains with headache.
    I read that this could mean candida but laboratory wise there is no indication (9 stool tests, 3 mouth smears and one LTT for the last few years all negative).
    Can this response mean something else like bacterial or viral infection?

    Thanks for any suggestion.

    • I develop a hoarse throat when I eat coconut oil. I am on antiviral meds. I have assumed my negative response is due to viral problems…. When I take l-lysine (antiviral), I have severe nausea. Again, I wonder if it is a ‘die off’ symptom. btw, I test with no allergy / sensitivity to coconut oil, but it does have antiviral properties.

    • Hi Mark,

      I doubt it’s fungal. I would suspect some sort of allergic reaction (http://www.allergy.org.au/patients/food-allergy/coconut-allergy), or else a gut bacteria interaction with some ingredient. You might want to test coconut milk on your skin to see if it generates a rash — and also test coconut milks free of additives or with different additives (guar gum, metabisulfite) to see if it is the additives that cause the problem.

  14. Hi Paul,

    I came down with severe constipation (no diarhea) about 3 months ago while traveling. I was drinking a lot of beer
    and not eating all that great. After increasing my fiber (which made it worse) I started reading
    about Paleo and cut out grains and legumes about 2 months ago. In addition to diet change I started
    taking L-Glutamine (with a small amount of Acacia and Glucosamine) and vitamins
    (many covered in your teachings). My constipation is pretty much gone for the most part.

    I’m now dealing with a mild ‘stomach twist’ when I eat certain foods (dairy sometimes but especially
    nuts). It’s not pain at all just a mild bloating and a ‘twisting’ feeling like I said.

    Where do I start? I’ve read I could have SIBO. Maybe Candida? Should I get a stool test or…?

    I’m really frustrated. Any direction you can point me in?

    Thanks!

  15. I have enjoyed great confidence that I might avoid the family osteoporosis that took down my grandmother, great-grandmother, and mother. Have been off wheat for 20 years, then I see this.

    http://www.plantbasedsolution.com/2013/12/08/phytates-antinutrients-or-essential-nutrients/

    What do you think? Paul?

    • I would also love to see Paul’s comments to Dr. Greger’s Nutrition Facts newsletters / videos. He presents this phytate data, data that even one egg a week, even minimal meat / animal based food, etc. is harmful. I have noticed that much of his data is correlational and epidemiological which can provide support but not proof…..Paul, your thoughts?

      • I’m going to do a blog series on the vegetarian issue when I get time. It’s perceptive of you to notice that their evidence is very weak.

        • I will look forward to reading it, Paul! My background is a PhD in experimental cardiovascular psychophysiology. So knowing about research has made me realize the considerable limitations of conclusions that are often drawn, the ‘tricks’ that can be played when presenting statistics (e.g. absolute vs relative risk), ‘cherry picking’ of data / studies, the importance of knowing who funds the research (e.g., Dr. Greger says that the studies on benefits / lack of harm of eating eggs have been funded by egg producers?), and so on. I remember being impressed when I first read your book that you seemed to present a variety of types of data and draw your conclusions from the preponderance of evidence. A persuasive approach.

        • Thank you both!! I’ll look forward to your insights. I was thrown by the comments in support of phytates, as they seem to be a significant problem for me. As I quickly scanned that article, I was very curious about those issues that Donna mentions — funding, special interests, cherry picking, etc. I am a confirmed non-vegetarian. So, vegetarianism is not a concern, but I do wonder whence comes this 180 on cereal grains and phytates. I would be frightened to start on them again.

        • Paul, looking forward to your vegetarian series. I’m hoping it will be done in your constructive style, as opposed to an us vs. them style.

  16. Two questions:

    1. Do you include bison among your recommended meats to eat weekly? If not, please explain why not?
    2. What do you recommend as a food replacement for someone severely allergic to eggs – other than perhaps considering a different diet 🙂

    Thank you so much!

    • Hi Jess,

      Bison is an excellent food, you can eat it as often as you like, as you can beef or lamb.

      I think you can eat extra liver and organ meats, and supplement choline, if you don’t eat eggs.

  17. Hi Paul,

    I just got some blood tests done and I’m showing a low white cell count and low neutrophils. (Red is normal)
    The result comment says ‘Slight neutropenia’. I’ve been eating mostly your diet for 6 months, so would this be diet related ?
    I have no idea what neutropenia is. 🙂

    Appreciate the help.

    • Hi Warren,

      If it’s really slight, I wouldn’t worry about it. Actually lowest mortality is at the very bottom of the normal range. When you have infections, your body makes more white blood cells, and most people have some infections. If you feel good, you’re probably just in much better health than the average person.

  18. I’m hoping Paul can give his take on the following question I’m facing.

    I’ve been eating Atkins induction low carb, evolving through Kwasnewski’s OD, to PHD for the past 4 years. For the past 2+ years my eating habits have been:

    About 32 ozs coffee with 2 TBSP grassfed butter and 2 TBSP 100% C-8 MCT oil in the morning. Nothing further until a PHD compliant dinner which consists of 90-100 grams of starch from rice or potato, 3 egg yolks, 1-2TBSP Ghee, meat protein (type varies) to reach about 75 grams, plus various veg. I also eat about an ounce of 70+ chocolate nearly every night.

    I deviate once a week from above to have dinner out with my family. I nearly always avoid grains and omega 6 oils.

    I am hypothyroid. For many years I was on levothyroxine T4. During this time my dosage slowly rose over time to keep my numbers “normal”. During this time my standard lipid profile was pretty much optimal in my opinion. TC 233, HDL 79, TRIG 65, FBG 95-99.

    I was not happy however with the way I felt, so I found a new doctor who would consider changing my thyroid meds to Naturthroid. That was done about Aug 1st of 2013. The thyroid number look pretty good and I feel pretty good.

    For thyroid support I supplement 12.5 mg iodoral iodine/KCL, 200 mg selenium and 3mg boron daily.

    This new doc is more of a cholesterol cop and he wanted me to start fish oil and niacin. I said no I’m good with my lipids. They have been stable for years and right in the sweet spot of where I want them. I asked him for an NMR test because I was interested in LDL-P based on the latest research. Unfortunately, the NMR test didn’t encourage me. TC 269, HDL 69, TRIG 67, LDL-P 1780, small LDL-P 645 LP-IR 33.

    To me the HDL,Trig and LP-IR numbers indicate my diet is in general a healthy one.

    I came across some research by Dr. K.C. Hayes from Brandeis that seems to conclude that there is a 18:2 fat threshold of about 25-30 grams/day below which saturated fat and dietary cholesterol WILL greatly impact LDL. Above this threshold of 18:2 intake, sat fat and chol seems to have little impact on LDL.

    I’m currently getting maybe 5 grams /day of 18:2 fat so I’m tempted to raise my intake of 18:2 to 25 grams/day, also increasing omega 3 to retain some sort of balance to see if my LDL-P comes down. Its a grand experiment to see what happens but it flies directly into the face of PHD and nearly all current claims about omega 6’s.

    BTW, I also supplement with liver and all the other PHD supplements so I don’t think my issue is copper or choline. I also eat about a pound of salmon and sardines a week as well.

    So, sorry for the ramble, but what’s the “safest” way to up 18:2 fats to 25-30 g/day? Am I crazy to try this?

    Thanks.

    • Hi scottts,

      I hadn’t seen the KC Hayes research indicating a requirement for omega-6 fats. The paper is here: http://www.ncbi.nlm.nih.gov/pubmed/1592210 and http://www.fasebj.org/content/6/8/2600.long.

      I think 25 g/day of omega-6 is too much. That is an amount that generated high mortality rates in clinical trials. Saturating its effect on LDL receptors and cholesterol is not likely to be an indicator of the optimal omega-6 intake.

      If you are committed to it, then you probably want to supplement tocotrienols along with them, and get the omega-6 from natural food sources such as nuts. Walnuts might be a good choice. But I don’t endorse this approach. I would look to altering the gut flora instead.

      Best, Paul

      • Thanks Paul,

        I really don’t want to up the omega 6, but it sure would be an intriguing experiment for a few months. I haven’t decided what to do yet and need to do more research on just how bad having LDL-P in the second highest quintile really is.

        When you mention altering gut flora are you meaning through the use of pro-biotics and/or resistant starch?

        Thanks.

  19. Limiting how much saturated and trans fats you eat is an important step to reduce your blood cholesterol and lower your risk of coronary artery disease. Eat more vegetables, fruit and foods with high amounts of Omega-3 fatty acids such as salmon, mackerel and herring. 😉

    • What?? Intake of saturated fat has very little effect on blood cholesterol and no effect on coronary artery disease.

      • Anyone read anything about the ApoE 4 gene? if you have it, they say dietary fat and cholesterol WILL negatively affect cholesterol levels including oxidized LDLs, and that dietary saturated fat and cholesterol in particular should be kept very low. I have read that with this 4 gene, there is a significantly higher risk for cardiovascular disease. They also say that 60% of people have ApoE3 and have no difficult metabolizing fats and cholesterol. ApoE2 will have difficulties with carbs and should be careful how much of them they eat (and that dietary changes are very helpful).

      • Some research indicates that the effect sat fat and cholesterol have on blood lipids depends on the 18:2 omega-6 fat in ones diet.

        Above a certain threshold of omega-6 and sat fat and cholesterol don’t seem to have much affect. Below that threshold and blood lipids appear highly sensitive to sat fat and cholesterol.

        I get over 100 grams of sat fat and 1000 mgs of cholesterol a day in my diet and just a few grams of omega-6.

        I’ve also been eating this way for a few years and only now is my LDL really rising to “dangerous” levels. Could it be that after years of low omega 6 intake, I’m experiencing a form of deficiency?

        Maybe I’ll just try to reduce 14:0 fats and see how that works.

  20. Hello Dr. Jaminet,

    I was curious, have you ever had any followers that have been affected by fluoroquinolone antibiotics toxicity? http://www.survivingcipro.com/ http://floxiehope.com/

    I had a reaction to 4 500mg ciprofloxacin pills just last week (they then switched me to doxycycline), I’ve gone from nearly a pro walker to barely being able from room to room due to joint pains and foot spams, in just a few days. My reaction has been fast compared to others apparently and am trying to contain it somehow.

    It puts a new spin on health issues, a lot of people diagnosed with autoimmune diseases and others claim they can tie it back to this antibiotic.

    In terms of the mechanism for its damage, largely unclear, but somebody summed it up as follows: “Some things are known. One is that the molecular structure of the quinolones in general causes them to be strong chelators of magnesium ions as well as several other essential mineral ions that have oxidation states of +2 (as does magnesium) or +3 [in other words, pulls the magnesium out of tendons/cartilage/etc, maybe leaving them calcified]. Another is that the fluoroquinolones have been found to produce oxidative stress and depletion of glutathione. It has also been reported that the fluoroquinolones raise the activity of metalloproteinase enzymes in tendon tissue (https://www.ncbi.nlm.nih.gov/pubmed/20602464), causing degradation of collagen. I don’t think it is understood whether or how these effects might be connected.”

    So mostly am supplementing magnesium and antioxidants and also have to take doxycycline as alternate antibiotic for the original issue (and from what I understand so far doxy may even be protective vs cipro effects). On top I’m doing some of the PHD recommendations especially for B vitamins, and while I had some neuropathic symptoms they seem to be under control with that. But my joint/ligament/tendon pain is certainly not improving.

    There’s a whole network of people affected by this, but I’m curious if you had heard of or have any takes on it. I had followed PHD not religiously but certainly the supplementation for some time before this happened.

    • Hi Pat,

      I haven’t heard any readers report it, but I know it is a very common experience. It is a dangerous antibiotic. I don’t know about the mechanisms.

      • I guess I might be your first then. Doctors are skeptical/useless of course (only 1 out of 5 even acknowledged it could be “tendinitis” for the joints), but their only alternate suggestion is that it could be a virus, which they then aren’t interested in testing for. I highly doubt it because of the neuropathy, which none of them seem to be aware of (FYI: http://www.fda.gov/Drugs/DrugSafety/ucm365050.htm !!!).

        I’m not hopeful, but I have to do something so I’m going to try to combine PHD tips with people’s experiences with fluoroquinolone toxicity.

      • (mostly tips regarding joint health, because I can live with neuropathy, but losing ability to walk is something else)

      • Oh and had to point this out: https://www.youtube.com/watch?v=A8HgZRwqrn0

        Short version: There’s mitochondrial damage involved in this condition, but even with this the first thing this doctor tries to address is gut health!!

  21. Hello Paul,

    Can man with candida or yeast infection eat mushrooms ? Thanks for your advise and answer !
    Best, Ingrid

  22. Hi Paul,
    Love the book, still much to learn.
    Since starting a Paleo and PHD type diet I have recently noticed that I have started to get issues with pain in joints/tendons/ligaments i.e. it has now become painful to clench a fist (worse in the mornings). It feels as though the muscles/tendons are too tight.
    I supplement with Vitamin C, K2 and D3 each day.
    Is there something else that I should be looking at that may be the cause of this?

    Kind regards (please keep up the great work)

    Terry

  23. Ghislain d'Entremont

    Hello Paul,

    I’ve had several symptoms of adrenal fatigue and/or hypothyroidism (hypoglycemia,low ‘reactive’ blood pressure, fatigue, occasional bradycardia) for the past 6 months, despite a lower than average yet still normal adrenal panel (four-point cortisol test)and normal TSH levels. With a concurrent onset, I had consistent gas build up in my upper abdomen, and a generally decreased ability to handle full meals.

    I am currently dealing with an H.Pylori infection. And my doctor believes, and I am convinced, that I’ve developed or worsened a chronic sinus infection since the removal of my wisdom teeth 5 months ago.

    I’ve tried a ketogenic diet, a very low carb paleo diet,and a diet resembling your PHD in terms of macro-nutrient ratios. They have all offered some benefits, but none of my endeavors have substantially improved my condition. I just finished reading your PHD book (in less than 24 hours), and I want to give it a try. However, I was wondering what variations you would recommend for both fighting infections and managing hypoglycemia, etc.

    I have tried intermittent fasting, well… intermittently, and have found that I can go through with it without too much difficultly only part of the time. However when it is ‘succesful’, I feel cleansed!

    How do you recommend I tweak the diet to satisfy my set of symptoms?

    I look forward to hearing back from you,

    Ghislain

    • Regarding the H. pylori, I strongly recommend you contact Dr. Marcus Ettinger in San Diego. He works with distance patients and has an effective H. pylori protocol. Easy to find him online.

    • Dear Ghislain,
      I have been thinking of contacting you for a while now. Ill health following the removal of wisdom teeth is very close to home. My daughter started to have all kinds of health problems following the extraction of her wisdom teeth. Hypothyroid, joint and muscle pain, fatigue, memory problems, digestive problems, insomnia and skin issues – to name a few. It took some time and effort to connect her ill health to her wisdom teeth extraction and a root canal that never felt right.
      I came across Dr. Graeme Munro-Hall, a biological dentist in UK, who wrote an excellent book on the topic of hidden dental infection and difficult to diagnose health issues.
      My daughter is now excitedly waiting for her treatment while practicing PHD diet. She found that lots of vitamin C and activated form of vitamins B (to deal with her MTHFR mutation) helps a lot.

      I hope that this will help you find and resolve the cause of your health problems. Dr. Munro-Hall book is available on Amazon. He also has a web site with some good information.
      Best of luck to you.

  24. Paul ( or anybody) I am in the hospital with 2 small bleeding ulcers. Once I get out, what sort of diet should I follow?

    • Have you been tested for H. pylori? If positive, I would suggest contacting Dr. Ettinger in San Diego. He has a natural protocol. You can find him online easily. He is a chiropractor.

    • Hi Davidm, Improve your vitamin A, vitamin D, vitamin C intake — liver, spinach, sweet potatoes, carrots for A. zinc and low but steady doses of iodine should help. Probiotics and salt might help also. Good luck.

  25. Liver/swimming rats?
    Does anyone know about the swimming rats “study”? It’s a story about three groups of rats all fed different diets and the group eating desiccated liver swam a good deal longer than the others. Now, I’ve heard some twists and turns, so who knows if this was really a study and what the results were.

    Anyone know about this?

  26. Hi, Drs. Paul and Shou-Ching (and anyone else who would like to comment),

    I don’t want to be a question-hog as I asked another question a while back. Other than consuming liver, our family is doing very well on your diet. Unfortunately, it seems ignorance is not bliss with regards to my blood sugar. I have felt better coming off a lower carb diet and transitioning to PHD; however, I continue to have a few nagging issues including feeling a bit drowsy after dinner (when I usually get most of my carbs i–usually sweet potatoes) and horrible sleep. I can usually fall asleep and then wake up between 3-4 am with horrible anxiety/heart palps that keep me up for the rest of the morning (dawn phenomenon?). I pulled out my old glucometer and decided to begin testing again.

    I’m still quite high at the 2-hour post prandial blood readings (e.g. 189 last night) and fasting blood glucose usually between 125-135. Yikes.

    I eat my starches in the manner prescribed in your book. I have even included some potato starch and have only noticed….gas (TMI). I tend to my circadian rhythms, but know I get SO little sleep for SO long now that I’m sure THAT is contributing to my BG readings. I quit coffee, too, by the way.

    I wonder if you or anyone else on this forum has any suggestions as to how I can help my hyperglycemic states I seem to fluctuate in and out of. You mentioned in your book that it would be a mistake to lower one’s carbs even if it seems intuitive to do so. It’s seductive, but I’m going to keep following PHD levels of carbohydrate. (As a side note: I’m a 44 year old female on thyroid meds for secondary hypothyroidism. Not obese, but need to lose about 15-20 pounds. Used to be very active and athletic.) I often think I may be doing everything “right,” but that something else is at the root of my issue(s).

    Thanks so much for your time–it is always appreciated.

    • Hi Laura,

      You need to work on immunity:
      – Vitamin A (liver, spinach, carrots, sweet potatoes; supplement if you don’t eat liver)
      – Vitamin D & sun
      – Vitamin C (to bowel tolerance)
      – circadian rhythm entrainment including daily exercise
      – intermittent fasting
      – zinc, iodine

      & then continue working on gut flora with fermented foods and fiber.

      Best, Paul

      • Thank you, Dr. Jaminet (Paul). I have my appointment with my Endo in a few days and am preparing–again–for the “you’re pre-diabetic” speech. Frankly, I would rather speak with you, so thank you for your response. I will concentrate on the bullet points you listed. You are a treasure.

      • Hi Laura,

        To keep your blood glucose readings down you could have more good fats with your meal, if you’re not already. (Coconut oil, butter, avocado)
        I also read, eating protein 30 minutes before your carbs can decrease your BG.

        • Thank you, Zaum! I do already eat plenty of the yummy fats with my meals–exactly the ones you listed, actually; however, I haven’t thought about timing the protein and carbs differently. Thanks for the suggestion!

  27. Here´s my story:
    I am 33 years old and suffer from different health problems since I was 18. Mainly gut disorders like bloating, diarrhea and large bowel pain. Additionally I often get terrible hypoglycemia (diagnosed insulin resistance), especially in the morning after breakfast and after physical and mental activity. My condition became worse last year when migraine and aura appeared several times for the first time in my life.
    Every important medical examination was made and most of them came without results. Stool sample showed no significant anomaly.
    Since a few years I cut out gluten (grains replaced by teff) which improved my gut Problems and hypoglycemia noticable.
    After reading your book I tried to cut out teff by replacing it with Rice and vegetable in the morning. Unfortunately my hypoglycemia came back horribly. Potato causes bloating so Rice is my safe starch that I can Digest without trouble. To cut a Long Story short, I don’t know how to start.
    Thank you very much,
    Florian

  28. Hi Paul,

    I have ordered the audio/MP3 version of your book on Amazon, but have both times received a copy that contains a book on Disc 1 called “The Peaceful Parent”, which covers the entire CD. I am assuming that there is some manufacturing error occurring, or is this actually correct? Disc 2 contains audio for “The Perfect Health Diet” book, but I am not sure that it contains all of the chapters. Can you please verify this for me before I attempt to return the replacement copy I received today to Amazon? Thanks..

    Steve

    • Hi Steve,

      I’ve emailed you with contact information for Tantor, the audiobook producer, who want to fix the probably directly for you while they simultaneously work on fixing the Amazon issue.

      If anyone else had this problem, email me and I’ll put you in touch with Tantor.

  29. Paul –

    I wondered if you saw this article on PBS News about combating Alzheimer’s:
    http://www.pbs.org/newshour/rundown/2014/01/10-tips-for-reducing-risk-factors-of-alzheimers-disease.html

    What caught my eye was #3 – You are what you eat. While the recommendations on Omega-3 seemed on the mark, I was surprised to see red meat on the list of foods that should be “banned”. Is MSM (Main Stream Medicine) so out of touch that they would go as far are recommend cutting out red meat??

    Thanks!

    Jim

  30. Hi Paul,
    I’ve been following PHD for almost two years now and I love it. However the following health issues remain:
    – Chronic nose congestion (it’s always present, but gets worse after meals containing carbs. It really ruins my sleep)
    – Fatigue, depression and eczema (gets much worse after eating fructose, even tiny amounts)
    After having tried many, many things I was sure that the cause of these issues had to do with my gut health. I wrote you some time ago and you told me: “It sounds like you have some sort of SIBO or bacterial overgrowth of the small intestine which is exacerbated by fructose.”
    So I decided to seek diagnostic help and did the 2200 GI Effects Comprehensive Profile from Metametrix/Genova. The results arrived today, and it seems you were right:
    – No yeast, no parasites, no opportunistic bacteria.
    – High Clostridia spp. (11.4, normal ranges: 1.5 – 6.2)
    – High lactobacillus spp. (8.4, normal ranges: 1.8 – 7.8)
    – High Firmicutes (79%), low bacteroidetes (21%)
    – Lactoferrin, mucus, WBC’s, PH, RBC’s, Pancreatic elastase 1, tryglicerides, putrefactive SCFA, LCFA’s and fecal fat and cholesterol are all good within normal range, so no problems there.

    I think that these results explain why fermented foods and probiotics containing lactobacilli, like Bio-Kult, give me digestive problems (bloating, indigestion, heartburn, belching). I take SBO’s (Prescript-Assist) now, and I tolerate those fine.
    My question to you is: What would you do to improve the situation? Would it be a good idea to take antibiotics, or would that be unnecessary? Any dietary strategies? I hope you can offer me advice/insight. Thanks in advance.

    • Hi Erik,

      The main things I would do are:
      – Circadian rhythm entrainment including exercise and light exposure
      – Intermittent fasting
      – Vitamin A — liver 1/3 lb/week plus lots of spinach, carrots, sweet potatoes/yams, persimmons;
      – Vitamin D optimization;
      – Zinc, iodine
      – Vitamin C to bowel tolerance
      – Additional fiber from a diversity of vegetables and cooked then refrigerated potatoes and rice
      – Selected probiotic supplements – limit Lactobacillus to L reuterii; SBOs are good; fermented foods

      I wouldn’t take antibiotics.

  31. Hi Paul,
    I have followed your blog for a long time and I am turning to you for help.
    My 16 year old daughter started with mild excema 4 years ago. In november, it spread like wildfire covering her arms, legs and face. She lost MANY days of school. Didnt want to go with the steroids but she was desperate. I am mostly paleo (hashimotos), and she tried AIP paleo and accupuncture along with the steroids. Started with a naturopath who changed her to GAPS. She is doing ok on GAPS except she is an elite distance runner looking to run for a big 10 school. The problem is she is “bonking” during races from lack of fuel. We try super loading with the squashes and bananas but it is not working. She has colleges looking at her and really needs scholarship opportunities. Bonking during races and losing 5 or 6 places is ruining that (and her happiness). I have read your input about safe starches and would love to hear what your thoughts might be on continued healing but with adding rice and potatoes. Please help.

    • Hi Margaret,

      If you do a search for Ben Greenfield, he sometimes does collaborative talks with Paul (from memory). Ben has podcasts and talks about being ketogenic on long distance races and adding on carbs pre-race and the types of things he recommends during the race. He also speaks about his bonking experiences and what he changed.
      From my experience, ketogenic is great for long steady racing… Not power based sports.

      Hope it helps.

    • Hi Margaret,

      First, for the carbs, she has to experiment a bit to find what she tolerates. White rice is usually well tolerated because it is low in fiber. If she reacts to rice, try dextrose powder. She does need a significant amount of carbs to support immunity as well as running, so it is important to get a source of carbs. As her gut heals she will be able to diversify her carb sources.

      Then, make sure gets optimal amounts of vitamins A and D. A — 1/3 lb liver per week plus lots of spinach, sweet potatoes, carrots, persimmons. She can supplement cod liver oil for A if she doesn’t eat enough liver. D– sun or supplements. Also, 225 mcg iodine per day, 100 mg zinc per week, and then get ascorbic acid powder and drink it in water to bowel tolerance.

      The next step is to tend to circadian rhythms, bright natural light in the day and red-yellow lights (or blue-blocking glasses at night. All eating within daytime hours (or before 8 pm).

      In most adults I would also recommend intermittent fasting, a 16 hour fast overnight and all eating within an 8 our daytime window. But young women often undereat when doing intermittent fasting, and this is a major risk with athletes. If she does this, emphasize the need to eat just as much food in 2 meals as she would in 3 meals normally. Don’t reduce calorie intake, just compress it. The fasting will help change the gut flora which is what you need.

      Finally, work on improving the gut flora with fermented foods and gradual introduction of healthy fibers from vegetables and resistant starch sources like cooked but cooled potatoes.

      Make sure her food is a balanced diet, and include coconut milk.

      Best, Paul

      • Hi Paul! Thank you for your suggestions for my daughter. We added a bit of white rice and she ran great. She felt powerful (her word!) However, her ezcema flared a bit and she became constipated again. Her constipation had been relieved since following GAPS. We are soooo frustrated. Would the resistant starch from something like Bob’s Red Mill mixed with water be an option. I read some research on Animal Pharm’s blog but wasnt quite sure the amounts and if it would apply to us. Thanks again, You are a great resource!!!

  32. Anyone have recommendations for dealing with perennial allergic rhinitis? I’ve suffered from chronic sinus pressure, congestion and irritation for over 6 years and it’s slowly ruining me and my life. I’m a follower of PHD and I’ve seen many health benefits but no improvement in the sinus/allergies realm. I’ve tried neti pot, quercetin, stinging nettles, high dose vitamin c, buterburr, spirulina but non have had lasting effects.
    I typically try to stick with research backed protocols/supplements but I’m getting desperate. I read online that a “sluggish liver” could be a contributing/causing factor. Does anyone see this as a plausible cause? Any help would be much appreciated, this is really taking a toll on me mentally, physically, emotionally, spiritually etc.

    • Have you tried eliminating all dairy? If not, you might want to try that, for a minimum of 3 to 4 weeks and see if you feel better. With sinus and congestion problems this is the very first thing I would do.

      • Thanks for the reply Hillary. I’ve eliminated dairy but probably not long enough to make a difference. I’ll go ahead an eliminate it for at least 3 weeks and report back, thanks again!

        • I would recommend daily neilmed sinus rinses. I do it 3 times per day. They have saved me from several sinus surgeries. Also, repeated infections can mean IGG deficiency, which can be checked by an immunologist.

    • Hi Jonathan, just wondering if you have been very strict on the Gluten avoidance. After YEARS of severe sinus issues (non allergic rhinitis) and trying many things including dairy elimination, it wasn’t until I fully got rid of gluten (for other reasons ironically) that I finally saw a huge difference.
      In fact, my ENT doc said he didn’t recognize my now normal nasal passages! 😉

      Also, I recommend really looking at things like the pillows/blankets you are sleeping on if you haven’t already, especially if you wake up congested in the morning.

      Good luck!

  33. Hi Paul,

    …have not bugged you in a while 🙂

    does inositol do the same ‘job’ as choline…
    or are they completely different

    • Hi Darrin,

      They are different. You need a balance of both, but more choline. Their main function is to form phospholipids by providing an organic water-soluble molecule for the blood- or cytosol-based end of the phospholipid. Choline has additional functions, as a methyl donor and as a precursor to the neurotransmitter acetylcholine.

  34. Calcium and phosphorus

    Given the huge emphasis on the composition of human milk in the book, and frequent discussions of all sorts of «ratios», I find it surprising that there´s no discussion of the calcium:phosphorus ratio, which is approx 2:1 in human milk.

    I would estimate PHD may typically provide more like the opposite ratio (maybe 0.5-1.2 gm Ca and 1.5-2.5 gm P / day).

    1/2 pound of meat/fish + 3 egg yolks + 2-3 slices of cheese (30 gm) plus a bowl of bone stock could provide 1.2 gm of P and 0.7 gm Ca if my calculations are correct. Coconut milk and dark chocolate would add several hundreds of mgs of P without much Ca.

    I have seen some in the paleo movement (like Denise Minger) recommend a 2:1 Ca:P ratio.

    I think hunter gatherers may ingest a much much higher Ca:P ratio than we are aware due to the consumption of organisms rich in calcium carbonate (the major component of their shell). I think insects, larvae, many sea organisms, ant eggs etc. Calcium rich water and wild leafy greens may further favor Ca in this ratio.

    In animal feeding the Ca:P ratio is considered extremely important, possible the most important of all the nutritional «ratios». Dogs and cats require a 1.2:1 ratio for optimal health.

    Any thoughts?

  35. Hi Paul. I was reading the book looking at the part where you discuss large intestine infections vs small intestine infections. I get strong bloating from fodmaps, and simply eatig plain old potatoes has not helped my constipation. should I use rice/ dextrose powder and go on a ketogenic diet as outlined in the book?

    • Hi James,

      I would focus more on vitamin A (liver, plus spinach, sweet potatoes, carrots), circadian rhythm entrainment, intermittent fasting, vitamin D, zinc, iodine, vitamin C, and collagen from joint soups and stews, and egg yolks.

      Then find the best tolerated carb source; maybe rice or dextrose powder. And eat fermented foods and probiotics.

      • Doing really well on the ketogenic diet outlined in the book, bowel movements about once a day, think I should stick with it? been feeling pretty good / less depressed

  36. Dear Paul, I am so very thankful for your book, website and for all I am learning from you. I have added many things to my diet as per your suggestions, but I was wondering if you could help me with one thing. My ceruloplasmin level is low – the scale is 20-50 (mine is 18 and my son’s is 19). We do not have Wilson’s Disease. But when I try to take copper (my hematologist wanted me to take 2 mg per day), the numbness in my hands and feet seems to get worse and I end up feeling more tired and lousy overall. My face even swelled up. I thought maybe it was a coincidence, but after stopping for a few weeks and then trying again, the same thing happened. The supplement is from Pure Encapsulations and is very hypoallergenic. I do great with their products. I also have never been able to eat shellfish or avocado’s…and many other foods high in copper. I am starting to add dark chocolate – a little bit, every day and have been fine thus far :). But, do you have any advice or know anything about ceruloplasmin? By the way, adding egg yolk, a brazil nut or two, and iodine has helped me immensely!!!! Thanks so very much for all that you and your wife do!!!! I am so grateful!

    • Hi Deborah, is it possible you are zinc deficient at the same time? Copper and zinc need to be in balance and extra copper will exacerbate a zinc deficiency. I would try supplementing zinc and see how you feel.

      I would also check iron status and make sure that is normal.

  37. Hi Paul,
    My iron panel shows elevated feratin of 320 ug/L. Iron level is normal at 19 umol/L, transferrin 2.8 g/L, saturation 30%.
    Is this a case if simply donating blood? My doctor is confused because my iron levels are in the normal range.
    Thanks,
    Adam.

    • hi Adam, Paul’s answer here, http://perfecthealthdiet.com/q-a/comment-page-66/#comment-285808
      may shed some more light,
      “High ferritin is usually a marker of either inflammation or iron overload. If you have an excess of iron (usually not the case in menstruating women), then you can donate blood. If it is inflammation, you want to fix the underlying cause of inflammation. PHD is good for that. You are right that you don’t want to become anemic. Ferritin of 142 is not that high, and you could easily become anemic if you tried to reduce it while having an inflammatory condition.
      My main advice is to tend to nourishment and immune function via liver and carotenoid rich foods (spinach, sweet potatoes, carrots), vitamin D optimization, collagen-rich stocks and stews made from bones, joints, tendons, vitamin C, zinc, iodine, and the rest of the PHD diet advice, and intermittent fasting and circadian rhythm entrainment”

      …hi Paul, if you read this, i had a short query re inositol (see a bit further up), i think it may be a short answer…cheers

  38. Hi Paul,
    I’m new to PHD just finished reading your book and I feel like it’s already helping! In regards to your book it says not to take niacin in large doses. I was severely depressed and suicidal for a long time, I started taking niacin to conquer that (per foodmatters.tv recommendations) I currently take between 4000-4500mg a day and it is working better than anything I’ve ever done! I’m hoping to eventually wean myself off the niacin but am not ready to do so yet. I am wondering how much harm it is I am doing to my body and what signs or symptoms I should be watching for?
    And one other question— white rice is considered a safe starch but what type of white rice? Sushi, basmati,jasmine,and calrose (plus more) are all white so are all those fine to eat? Is it any rice that’s white in color that’s not instant? Or what should I look for on the ingredient list?
    Thank you ahead of time; your help is extremely appreciated,
    Jennifer

    • Hi Jennifer,

      Niacinamide can be therapeutic for some conditions and it’s good that you’ve found this therapy for yourself. Niacinamide supplementation can actually extend maximum lifespan, but it can also promote bacterial infections (though it supports immune function too), so it has some risks. I wouldn’t worry too much for the time being. Improve your health in all the other ways we advise, and then test to see if the niacinamide is still helping you.

      All types of white rice are safe. You can eat instant rice and parboiled/converted rice, which are high in fiber, as well as the other varieties you list which are lower in fiber and more digestible. The fiber in instant rice is beneficial for most people but can cause problems for some people with gut dysbiosis, so if you have a bad reaction to it switch to the uncooked varieties of rice.

      Best, Paul

      • Hi Paul, Will niacin feed viral (e.g. HSV) infection? And does no flush niacin have the same health benefits (e.g. immune function, lowering cholesterol) as niacinamide? Thanks, Donna

      • Hi Paul. Posted a question a while back and haven’t heard from you. Sorry to pester but would be really interested to know. Will niacin (no flush) feed viral (e.g. HSV) infection? And does no flush niacin have the same potential health benefits (e.g. immune function, lowering cholesterol) as niacinamide? Thanks, Donna

        • Hi Donna,

          There’s next to no data in Pubmed on niacin for HSV1. Nicotinamide does help with enterovirus (http://pmid.us/19382275), HIV (http://pmid.us/7763268), and vaccinia (http://pmid.us/2965468). The anti-vaccinia mechanism would probably work against any adenovirus, http://www.ncbi.nlm.nih.gov/pubmed/2941933. I think it would probably help against HSV also. However, there is one paper indicating that a niacin metabolite aids HSV1 replication, http://www.ncbi.nlm.nih.gov/pubmed/9791032. So, buyer beware.

          • Thanks, Paul. Interesting. I will try again with caution perhaps. The no flush niacin seemed to help lower my LDL when I tried it last time. I am now trying to think of the ‘not feeding the virus’ approach. For instance, it seems I am sensitive to arginine & arginine/lysine ratio and cannot take lysine as a supplement (nausea)[do you know anything about this?]. Therefore, have had to eliminate nuts, as well as a gelatin supplment I had been taking for arthritis & osteoporosis. Do you know what the argine/lysine #s look like for bone broth? Eating more yogurt for the lysine these days. I am now needing up to 6 grams per day of valcyclovir at times to deal with acute pain (sciatica – my thigh was even swollen – SI joint pain, spinal and other joint pain; a suspect abdominal pain episode [abdominal zoster or HSV1?]; weak breathing muscles, nausea so wondering about vagus nerve infection?etc.); bumpy rash on thoracic spine where I experience pins & needles; etc.. Any thoughts on what might be feeding the HSV in me would be appreciated i.e. food, supplements? Many thanks, Donna

  39. Hi Paul,

    Will taking my supplements first thing in the morning with a glass of V8 juice interfere with intermittent fasting or should I just take them with good old fashioned water?

    Thanks for all the great work you and your wife do and your willingness to share your expertise!!!

    Susan

  40. Hi Paul,

    For fermenting vegetables, I was considering purchasing a 5 Liter Pickl-it. Whenever I remove vegetables to eat, I would replace it with water and salt to keep the oxygen level at bay.

    When I called Pickl-it, they suggested that I do not do this and that I transfer from the larger pickl-it into smaller ones. They said that adding salt/water will somehow disturb the chemical balance.

    Is this a valid concern or can I simply replace the lost volume with water and salt? And after all vegetable matter has been removed to just drink the final water/salt.

    Erich

    • Hi Erich,

      Yes, it’s a valid concern. The bacterial populations are highly sensitive to acidity as well as food supply, and diluting the solution with water and salt will increase the pH and change the mix of flora. The mix is healthiest when the brine has turned sour/acidic. At more neutral pH, it is more likely to breed pathogens.

      If you have enough refrigerator space, try transferring all 5 liters to ~5 smaller containers that can be sealed with little oxygen, and refrigerate all of them to slow fermentation and eat them one at a time.

      But really, I think it’s better to ferment in smaller amounts. Figure out how much you fermented vegetables you eat in a week, buy a Pickl-It of that size. Get three. Start fermentation on a weekend, 3-7 days later open it and start eating, keep it in the refrigerator from then on. Seven days after you started fermentation, start the second one. Soon you’ll have a cycle where one Pickl-It is fermenting at room temperature, one is being eaten and stored in the refrigerator, and one is drying after being washed to sterilize it.

      Yes, you can drink the juice.

  41. Hello Paul,

    Could you tell which one you would recommend : sauna or hammam ?

    Thanks and many best wishes for this new year !

    Ingrid

    • Hi Ingrid,

      It’s good to heat up your body from time to time, so both are healthful. The hamam/Turkish bath is more likely to spread infections through the water, so I would probably recommend the sauna, but the hamam is fine. I think it’s best to alternate hot and cold, eg leave the sauna for brief cool showers periodically.

  42. HI Paul — I read several of your posts on multiple sclerosis, and I was wondering if you could speak to Dr. Roy Swank’s stance on red meat (specifically ruling out beef). A loved one who was recently diagnosed with MS has started to remove red meat from their diet, and I am concerned that that may not be the best decision. I know that you have posted some correlational research on the role of pork in one’s diet, and how that might be a likely suspect or contributing factor.

    Your thoughts would be greatly appreciated.

    • I would remove processed meat and pork liver, blood, and intestines, and would thoroughly cook other cuts of pork. But I would definitely include beef, lamb, and goat. Also, I would give blood regularly (unless menstruating or pregnant) to control iron levels.

  43. Hi Paul! I have been busy with a newborn baby so haven’t been keeping up with the blog recently but I found something interesting that I wonder if you’re familiar with. It’s the documentary “Why Am I Still Sick: The Silent Role of Biofilms in Chronic Disease” and companion film “Epiphanies in Microbial Infections.” The filmmaker suffered from mycoplasma pneumonia infection and created this documentary after his journey back to health. Although I haven’t seen the films yet, I like that this information is becoming available to the mainstream in various mediums. http://www.whyamistillsick.com/

  44. Hi Paul:

    I’ve read your book several times. Let me respectfully challenge you with five questions:

    1. How are your beliefs and ideas on supplements similar with concepts related to orthomolecular medicine (OMM)?

    2. Other than food therapies which I agree are good, in what ways do you believe OMM is credible? How do you feel your beliefs align with OMM or Integrative Medical approaches and how do know your research is thorough enough?

    3. Why do you mention Dr. Cathcart in your book if he is a controversial figure that practiced ideas of OMM on many patients (something unrecognized and frowned upon by mainstream medical/scientific community)?

    4. What potential risks do you think exists in touting the addition of numerous supplements to the diet given toxic levels of vitamins or other elements can occur if one deviates from your diet plan every so often?

    5. Since methylfolate (5-methyltetrahydrofolate (5-MTHF) and 5-formyl tetrahydrofolate (5-FTHF) are non-toxic unsythetic FOLATE forms, why don’t you recommend the form in conjunction with food? How is there danger from this form of folate?

    • Hi Eddie,

      1. I’m not sure because I’m not that familiar with orthomolecular medicine.

      2. I think it’s true that nutrition is very important for health. Our research was as thorough as we could make it in time available, but there is always the possibility that we overlooked something and need to revise some findings.

      3. Dr. Cathcart tested vitamin C on hundreds of patients with interesting results. I’m not aware of anyone else who has done similar clinical testing.

      4. I think our advice is pretty robust. If people deviate, it’s liable to be toward less nutrient dense foods, therefore I don’t think they will develop an excess of anything.

      5. If I recommended folate supplementation, those would be excellent forms. But I think food is sufficient for folate, so there is no need. Yes, there are risks from excess folate.

      • Hi Paul and thank you. I suggest a collaboration of your thoughts and analysis in the area of OMM with relation to how it may or may not correlate to the strategies outlined in your book. This would be a rather interesting topic to checkout in your blog. Cheers!

  45. Hi Paul,

    could you refer me to any (good) info regarding supplementing with 5-HTP or L-tryptophan before bed to fight insomnia.
    either on your web site (i seem to recall you’ve discussed this a long time back), &/or on other sites.
    …is one worse/riskier than the other

    • Hi Darrin, I oppose supplementing either because they promote bacterial infections.

      Instead, I would try (a) honey in warm milk before bed, (b) magnesium in the evening, (c) a choline+inositol supplement, (d) attention to all 5 circadian rhythm zeitgebers but especially light exposure, meal timing, and exercise, (e) general gut health strategies including vitamin A (liver), vitamin D, vitamin C, collagen (bone and joint soups and stews).

  46. Hi,
    I am new to this diet and a bit at my wit’s end. My brother, who is diabetic, recently talked me into trying a “moderate carb” diet. I have bipolar 2, which is less severe than type 1. I go on and off medications, due to hating the side effects, which include overheating and being tired a lot. I can function without them, I just don’t feel particularly happy. I also had my gall bladder removed many years ago, and additionally, have bad digestive reactions to eggs.
    I felt better the first couple of days or so I tried this diet, but it’s been a week and a half and I feel horrible. I am constantly tired and irritable, with things becoming worse from late afternoon into the night. My stomach and body hurt. My eyes and much of my body are also very itchy.
    I am only taking vitamins C and D thus far. A typical day’s diet lately is as follows: Dannon Light and Fit Greek yogurt for breakfast, mid-morning an Atkins bar and maybe some almonds, lunch has varied from an Atkins frozen low carb meal to homemade chicken spinach lasagna with rice pasta, kerrygold cheese and coconut oil. Late afternoon, I will have a homemade paleo brownie, then perhaps a few rice crackers or potato chips dipped in hummus. Dinner has been everything from canned, low carb soup to potato skins with cheese and meat on them, to a grass fed burger on low carb bread and some potatoes. I also drink about two cups of black coffee per day, I can’t seem to function without caffeine. If Paul or anyone else has suggestions, I would be really appreciative.

    • Tom,
      I personally would ditch the Danon yogurt, because It is full of crap.
      If you can tolerate dairy I would go for an organic unsweetened full fat yogurt.
      I used to make my own, but have digestive issues so I gave up dairy all together, and feel much better. Another recommendation, stay far away from Atkins packaged products, especially the bars because they contain malitol, which is an undigestable sugar alcohol. It’s nasty stuff.
      The premise of the Perfect Health Diet is making real food. I think once you get rid of the prepackaged foods you will feel better!
      Sandy

      • I tossed the last Atkins shake in the trash and also the Splenda sweetened jam. I haven’t been feeling very well, though. See below for more details.

        • Tom,
          I’m glad to see your not eating the Atkins products, and artificial sweeteners! One suggestion I have is to get checked for MTHFR gene mutations I just found out that I have homozygous
          C677T mutation, and it explains a lot. Bipolar is one of the symptoms. It just means that certain B vitamins need to be taken and no processed foods and certain medicatiions to avoid .
          Good luck
          Sandy

          • Thanks for the info, Sandy. The iodine seems to have made a difference and I do feel some better today, just a bit ache-y and off still. I have started taking B12 once a week but plan on getting a B complex.

    • Hi Tom,

      Well, it’s important to go step by step. You didn’t say what you were eating before, but I’m guessing it was low-carb. It’s not uncommon to develop an intestinal infection/dysbiosis on low-carb and then have difficulty when they are added back.

      The egg sensitivity is an indicator of impaired digestion and leaky gut. Try addressing that first: vitamin A (liver, spinach, carrots), vitamin D, vitamin C, collagen from bone and joint material, adequate salt, iodine, zinc. Take vitamin C to about half bowel tolerance. Tend to circadian rhythm entrainment as in chapter 42 of our book. do intermittent fasting.

      When you eat eggs, eat only the yolks, mix them in with other foods, and warm them. This will make the compounds you are sensitive to more digestible.

      Bipolar is a disease of circadian rhythm disruption so you need to make circadian rhythm entrainment priority #1. Nutrition can help you fix the SIBO/wounded gut/stomach problem that is causing the sensitivities and inflammatory reactions.

      Ketogenic dieting may also help, add coconut milk for that.

      Best, Paul

      • Thanks so much for your help, Paul. I’m going to give it a try. I think Sandy is right too, I’ve been eating way too many processed low carb foods out of feeling tired all the time and being lazy. I was previously eating the standard American diet, then switched to low/moderate carbs about a week and a half ago.

        • Tom – to make it easier to stick with PHD try thinking in terms of most of your groceries should be coming from the periphery of the stores which is where the fresh produce, meats, fish, etc… are usually located. Make quick forays into the heart of the store to pick up good fats.

          Also I find it helps enormously to prepare at least some of your week’s food in advance, as Paul describes in the book (and particularly in the new paperback edition which gives more details & ideas on this topic). This is especially important for the bone broths which require time to prepare, but can be made in volume.

          Another place to look is in Melissa Joulwan’s paleo cookbooks (Well Fed, and Well Fed 2) where she details how to easily prepare certain foods (mostly the proteins) in advance to quickly prepare hot meals on busy days.

          • Thanks! Of course I know that the Atkins and processed stuff isn’t good for me. Thanks for the book recommendation,that sounds perfect. I am having a rough evening. Started feeling horrible after work. I work a very stressful customer service job that I don’t like, but excel at. To keep up my friendly, lively work personality, I drink tons of caffeine, mainly black coffee, but the occasional diet soda. Today, I had a diet energy drink. After work, I went to the bookstore and bought the PHD book. I then went to Whole Foods. While looking around, I started having stabbing pains in my sides and felt miserable. This has happened in the past, had every medical test offered with no result, finally diagnosed as fibromyalgia. I personally think it’s caused by stress and too much caffeine. I picked up some berries, raw honey, iodine. When I felt the store, I felt completely drained. I sat on a bench and drank half of a probiotic drink and ate half of a Macrobar. That helped some. Walked the 15 minutes to the bus stop instead of taking the train, so I could get my blood pumping. After getting home, I drank a single serving bottle of carrot juice and ate a piece of paleo-ish, chicken/spinach lasagna made with rice noodles. Took my daily C and D, took some of the newly purchased iodine. I feel some better, but still exhausted. To make matters worse, a small lump I’ve had in my groin area for years has suddenly become very swollen and painful. I have been unsuccessful in getting an appointment with my GP. They have asked me to call in again on Monday or to go to urgent care this weekend, but I hate using up half my weekend when I feel uncomfortable, but not like I’m dying. I feel very depressed and discouraged.

          • I hope you feel better soon, Tom.

      • Thanks Paul.
        The iodine seems to be helping. After I took it last night, I felt a pleasant warm sensation inside, but I also felt chilled on the outside. Not sure if that makes sense. I feel some better today,but still ache-y and a bit off. Heading out for magnesium and K2 today.

      • I just wanted to report that I am feeling sooo much better tonight it’s amazing. I am not a 100 percent, but greatly improved. I tried very hard to eat PHD compliant foods all day. I think I figured out that a lot of the stomach issues and feeling bad I’ve been having are from the diet sodas and diet energy drinks I consume every afternoon at work. Today, I met a friend for coffee around 2 pm and ordered a cafe au lait. At 6 pm, we were still at the coffee house talking. I felt great the whole afternoon. There is a Starbucks near my office, so obviously I need to go get a cafe au lait when I need an afternoon pick me up. I am having a bit of muscle soreness and am wondering if it could be the histamines from the vitamin C that someone on here mentioned? Also, I bought magnesium citrate today but it looks like this brand adds a small amount of B6 to theirs. Is this okay to consume daily?

  47. Wondering what my numbers mean:
    HDL = 101
    LDL=223
    total cholesterol = 335
    trigl = 54. Mercola’s ratios seem good, but 335 sounds really high. Doc didn’t panic (he eats high fat because of his Parkinson’s) but suggested I have a heart scan to see if I have blockages. Two small patches of xanthelasma appeared a few months ago, and some say that is a sign of pending heart disease.

    I believe I eat within PHD range for safe starches. I have not paid attention to iodine supplementation, and total rigorous activity this time of year is just up and down the school stairs, several times a day. Have not been eating eggs daily because they ticked on an allergy test, so I doubt I am getting adequate choline. Have just begun weekly (and weakly) liver. Averaging quarter pound of beef liv for the past three weeks. Above test was August 15. These test results would have sat in the folder had I not called for an appt. This is irritating. This doc does not seem to call for follow-up when results come in.

  48. Hi Paul, I am struggling with interstitial cystitis that came on suddenly after a 2month battle with a yeast infection. I took diflucan and then it seemed to cause the candida to go to my bladder. I have been on a strict candida diet for 3 months with minimal improvement and just recently bought your book and added back the safe starches. I also have suffered with adrenal fatigue for years and been on a very low-dose of cortef because of severe insomnia i got 7 years ago. The insomnia resolved with the cortef but i began to live it up and eat a bad diet and then got the yeast and interstitial cystitis. I am wondering if you have seen a correlation between candida and i.c.? Also, If you have any other suggestions. Thanks! Jen

    • Hi Joy,

      You should definitely eat more carbs, aim for 30% of calories from carbs – they’re needed for immunity to Candida and you will get systemic candidiasis if you go too low carb. Also support immune function with zinc, iodine, vitamin A, vitamin D, vitamin C, circadian rhythm entrainment.

      I think you should follow the general advice in our book as most of the systems you describe can be effects of being too low carb, or malnourished in some respect or other.

    • Almost all pelvic pain disorders are interrelated. I suffered from both for many many very depressing and frustrating years. I took diflucan twice a week for over four years to try to keep down the histamine response I got from minute levels of yeast. For me, very low carb helped for awhile but then I moved to a more moderate level as Paul suggests. Eventually I found certain triggers such as nuts and citric acid (which are pretty common as IC triggers.) I can not take any type of vitamin c other than what is naturally found in vegetables (citrus fruits are too strong). I also had to do a very low oxalate diet for about a year, now I just avoid the highest oxalates.

      Low oxalate and no white foods is a hard diet to combine with PHD as potatoes and sweet potatoes are high in oxalates and too much white rice tends to make me itchy with yeast. My compromise is to use winter squashes and a few bananas and make sure I eat enough other moderately high veggies to keep my carbs up between 100 and 150. Maybe not ideal but it is the best I can figure out.

      Most yeast issues, vulvodynia, IC come about as part of an overall autoimmune or inflammation process like you mention. Paul is right to advise to continue working on overall health practices.

      • AnnC, Have you found that your ic symptoms have gone into remission with adding more carbs?

        • No, for me, there turned out to be no “one answer.” It took a long time and a lot of changes. The thing that is really better now is that I will go months and months with no flare ups and feel perfectly normal so that is fabulous after being so sick for so long. But it is never totally gone, if I mess up my diet or lifestyle too significantly I will get a massive flareup but it won’t last too long if I go right back to good health and my own diet needs. Often I spark a flare up by trying to improve my diet like the time I decided to heal my gut by increasing fermented foods. That was a major disaster for me, I can’t tolerate them at all (other than one or two brands of yogurt.)

          Also, I’ll have more issues in June when grass allergy season starts up and it adds to the level of histamine I have in my system. Or if I get really strung out emotionally or physically I will start to have issues.

          It is all related and, for me, a balance needs to be maintained. And I need to not jump on every new diet miracle cure…I need to try tiny steps instead and see how it goes.

          I have just finally gone gluten free and I’ll see if this is another big piece of the overall health puzzle, I think it probably is as my constant brain fog pretty much was gone within days.

          • For me, mold exposure (environmental or food) aggravate the problem++. I have also wondered about HSV virus (I’m constantly on meds for cold sores).

          • For me, mold exposure (environmental or food) aggravate the problem++. I have also wondered about HSV virus (I’m constantly on meds for cold sores).dMannose helps daily.

  49. Does anyone have problems with coconut oil? Backstory, I have a history of yo yo and restrictive dieting (macrobiotic at age 15, cycling through crazy diets since then) plus 3 pregnancies and breastfeeding have left me nutritionally malnourished, I think.

    So, after a few months on PHD I was losing weight with no problem, my compulsive eating and eating disorder symptoms were gone, I felt great, had great energy, etc. etc., tolerated IF very well, but then noticed that every time I ate anything in coconut oil I got a sore throat right after and some fatigue symptoms. I tried removing it and using a variety of other fats to cook with and for some reason the whole PHD fell apart for me after that — my food cravings and compulsive eating came back with a vengeance.

    So, after being off the PHD for several months and feeling totally crappy as well as gaining back 15 lbs and suffering a terrible winter cold/flu like I haven’t had in years, I’m gearing up to go back again. My question is, is it okay to keep eating coconut oil even if I have mild auto-immune response and otherwise feel great?

    Thanks in advance. Second question, does anyone have any experience with curing fructose malabsorption? It is something I’ve also suspected is the culprit (coconuts supposedly have fructans, which are problematic in fructose malabsorption as well as fructose).

    Thanks in advance.

    • I’ll also be curious to see if anyone has any ideas too as I get a sore/irritated/congested throat if I take even a small spoonful of coconut oil straight. (No problem if I cook or bake with it; haven’t tried to drink coconut milk). Feels like an allergic reaction. I have wondered if it could be a ‘die off’ reaction (i.e., if it is topically killing pathogens, e.g. HSV which causes cold sores, cankers; I have a big problem with that virus).

    • hi elizabethe,

      from what i have read (‘around the web’) some people do react to coconut oil…especially raw/unrefined/virgin coconut oil.

      so if the stuff you have is raw/unrefined/virgin, try some refined coconut oil.
      you can still get good quality refined coconut oil, i have some myself, labelled as organic coconut oil – refined cold pressed.

      the refined stuff (usually) has a much milder smell & taste then the unrefined stuff (which is a bonus to some).

      • Thanks Darrin, I already eat unrefined coconut oil (though I actually love the taste of unrefined!). I’ve been doing okay on it this time. I’m wondering if Donna is on to something with her comment.

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