Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. Hey Paul,

    I’ve been following the PHD for about a week now, and I notice that I generally get a very large bout of malaise (brain fog, lack of energy) particularly after eating. Furthermore, I notice that it is even worse when eating a carb dense meal. I have no known allergies and experience this reaction with any food combination. I have yet to find a consistency in my meals that elicit a crash other than carbohydrates.

    • My son calls this “carb crash”. I found that I was depressed for about two weeks after starting PHD diet. After that, I was fine.

  2. Paul –

    I’m trying to find some literature on the benefits (if any) of alternative sugar sources (like coconut sugar or palm sugar) over traditional cane sugar. Are there any? What I did find indicated that coconut sugar is still 79% sucrose – which will still break down into glucose and fructose. I didn’t see coconut listed in the table on nutritional content for sugary foods (Chapter 10). So is that any better than cane sugar…or is it just “hype” by the manufacturers to take advantage of people becoming more interested in their health?



  3. Hi. I was told I had gallstones 8 yrs ago, but never had any symptoms. I’ve been working out for 2 years and eating a balanced diet with protein at every meal, especially high protein (egg, greek yogurt) after my workout. I noticed that I was gaining muscle, but the stubborn fat on my belly and around my wais would not go away. So, I made a change. A month ago I started drinking green smoothies daily and eating a mostly vegetarian diet with limited animal proteins (cut out my daily eggs and greek yogurt) and limited nuts and seeds (I had noticed these made me look and feel bloated). Since then I’ve actually looked better, and I still have retained muscle (though in some places not as much). I did, however, experience 2 painful gallstone attacks and looked yellow (after eating fish with arugula and another after a green smoothie with mustard greens). I stopped consuming these two bitter greens because I’ve read they could be responsible for my gallstone attack. I understand that I need fat for my gallbladder to function, but don’t know if it’s the bitter greens or the fat that are giving me issues. I don’t want to eat the full fat and put on the weight I’ve lost and feel bloated again…I finally look really fit and feel great (aside from those attacks). I don’t want to keep eating foods high in oxalates if it’s going to hurt me more, though. And I don’t want to eat foods high in fat if that’s going to make me pack on the pounds and make my gallbladder worse too. I don’t know what the happy medium is where my gallbladder functions perfectly and I keep the physique I am now happy with.

  4. I’m not sure how to use this site. I recently started a low-carb diet and am somewhat confused by the different versions. I have read your book and it seems the most balanced one, I only hope it can help me lose weight.

    However, I have a moderate allergic reaction to eggs and so your recommendation to eat lots of egg yolks is not possible (I love them but they make me a bit nauseous after I eat them). Can you suggest what I do to replace the nutrients I will lose by not eating them?

    • Kate, you may not have noticed this, but Paul recommends egg YOLKS (3 per day), not egg whites — and it’s the whites that usually cause the problems. A tip: separating whites from yolks is much easier if the eggs are room temperature than if they are cold. Leave them out a few hours before you prepare them, and the yolks really don’t need to be cooked (traditional French mayonnaise, for example, isn’t cooked; avoid the store-bought kind, as it’s full of omega-6 oils).

  5. I am struggling with a relatively severe case of adrenal fatigue, and am receiving treatment for it. Are there any reasons why your diet would be contraindicated for me?

  6. Hi Paul, your freakin awesome! Quick question, does the consumption of resistant starch via potato starch for instance also feed bad bacteria along with good?

  7. Hello Paul,

    Thanks for the time you take to read and answer our questions and thanks for the one you give with patience and competence.

    Could you tell me what you think of this :

    Dr Clark seemed to agree with the fact you defend : most of the diseases are generated by bateria, viruses, and parasites.
    Anyway, What kind of credit to give to this “electric tool ” as a complement to your healthful diet ?

    Thanks and blessings,


  8. A friend of mine has a son (2 years old) who is severely constipated, sometimes for a whole week, he has already been taken to the hospital recently and they found the stool up near his stomach.. last week after 5 days they gave him an enema at home but nothing came out.. what could be going on there? what should they try? any suggestions would be highly appreciated. M

    • This sounds like a lack of beneficial bacteria in the gut, due either to a lack of fermentable (i.e., soluble) fiber, or some other source; it sounds like he need probiotics. Chris Kresser has mentioned that he finds the Prescript Assist brand of probiotics the most helpful with constipation; I’d assume you could open capsules and give small doses (in food), appropriate to the child’s size. Yogurt or kefir and mild, soluble fiber might also help. Also search this site for Paul’s other suggestions re. constipation.

  9. Hello Paul,

    Can we take psyllium husk as a supplementry form of fiber ?

    Thanks !! 🙂

  10. Hi Paul, I am still a bit confused about Gluten stuff.

    For example would it be ok sometimes to have Gluten Free pancakes for example? or Gluten Free Bread?
    Or does it still contain antinutrients?

  11. hi Paul,

    do you have access to this study,
    (Dietary factors in arteriosclerosis: Sucrose).

    if so, may be you could help me out…
    in an article here, http://www.raisin-hell.com/2011/06/how-fructose-makes-us-unhappy.html
    the author references that study and states that fructose raises (spikes) cortisol.
    specifically it reads “Fructose is the only carbohydrate which produces a significant spike in our cortisol levels”.

    So if you are able to view the whole study, could you take a look to see if there is anything in there that would back that claim (that fructose significantly raising or spikes cortisol).

    I cannot find any other info that would back this up. in fact everything i see tends to show fructose has the least effect on raising cortisol, compared to sucrose, glucose, (protein?)

  12. Greetings Paul,

    I have been experiencing excessive urination and bloating for many years now. I have experienced bloating from: dried fruits, bananas, apples, nuts, dairy, rice and gluten. This has been settled for the most part by following PHD. The urination, which is a bit more complicated, has been induced by: dairy, gluten, carrots, cucumbers, and leafy greens. I suspect other vegetables as well but these are the chief offenders. I have observed that thoroughly cooking the vegetables like carrots reduces this problem. I have no trouble with broccoli in all it’s forms. The urination is my chief complaint.

    I thought one possibility to be with my insulin response system but what sugar do leafy greens and cucumber have? I have frequent sugar cravings. After a big plate of rice, sweets or dairy, I would have slightly blurred vision and my toes and fingers have worse circulation than normal. However, my fasting blood sugar is 76-85 and my HbA1c was 6. I had some ozone infusion done recently and the doctor’s were worried at how dark my blood was (despite my acute athleticism).

    Then I thought I had fructose, lactose and gluten sensitivities, but this still does not answer my gripes with veges. Can gut flora affect what goes out through the bladder?

    I am on PHD and have found it has helped greatly by removing some of the problem foods but am still in a bind regarding veges. I am in a country not likely to find doctor’s or nutritionists who follow our school of thought, but I do have access to labs and hospitals where I can get all tests done and analyze them myself. Please help!

    • Zachary, I hate to tell you this, but you are in the early stages of diabetes. According to the NIH, “A normal A1C level is below 5.7 percent.” Between 5.7 and 6.4 they consider “prediabetes”, but others would consider anything 6 and above diabetes. But this is just a quibble about definitions. Excessive urination is also a symptom of diabetes. You say, “After a big plate of rice, sweets or dairy, I would have slightly blurred vision and my toes and fingers have worse circulation than normal.” These are classic symptoms of sugar high sugar excursions. Don’t be deceived by your low fasting glucose numbers, which can be caused by reactive hyperglycemia (many type 2 diabetics begin as hypoglycemics). Treat this seriously: Get a glucometer and use it at 1 hour and 2 hours after each meal to see where you’re at. DON’T eat large quantities of carbs (of any sort) at one sitting; eat the lower end of Paul’s recommendations for carbs, space them out into smaller meals. Make sure your exercise program builds muscle, not just cardio. And find a medical practitioner experienced with diabetes; if you can’t get the sugar levels down to where you don’t have symptoms of excessive urination, blurred vision, and problems in the extremities, you’ll need to get on metformin. See Jenny Ruhl’s site(s) for discussions of how metformin is the only drug that is safe for diabetics.

  13. Paul and Shou-Ching I have been working on perfecting my diet via low carb (paleo style) eating for several years now with the largest benefit being the expulsion of wheat from my diet. I have been reading your book these past few days and alogn with other source material about plant toxins I am wondering if you might respond to a question or 2.
    I am married to a Korean so I have been eating plenty of Korean food for the past 35 years. But it was not until recently gained knowledge of plant toxins that I began to wonder about some of the “weeds” that are in the Korean diet. I am sure you might be familiar with some if not all. My question is do you know of any that may be more toxic, or does the boiling reduce them, such as in Chigumsi, or Kosari especially. I know that the fermentation of the various kimchi’s is most useful and I love all of them!
    The other question is, do you know of some Korean resources that I can get for my wife (in Hangul) that help explain your theories, my wife still listens to the normal Korean medical shows that are just now seeming to catch up but still put the kabosh on saturated animal fat.

    Hope you can help me out just trying to keep her more fit as we enter our senior years, I am 57 and she is 60.
    Thanks ofr all you work and keep up the knowledge flow!


  14. Paul – thanks a lot for the work you’ve put into PHD. I feel awesome eating the diet you recommend. However my sex drive seems to be very low. I’m male, 27 years old, in good shape and eat according to your plan. Lift weights a few times a week and walk a lot. I’m single but not very interested in girls at the moment. My sex drive have been going up and down quite a lot through the years according to how my diet have been. It seems like it’s at its highest when I eat a lot more carbs than what you recommend in your book, and it have been at its lowest while I was eating low carb paleo (no starch). I’m not sure what to do, but I would like my sex drive to be high as I’m a young single male. Any advice on how to approach this without getting unhealthy or fat? Is it even normal to have high sex drive year round, or would it be more natural that it follows some kind of season depending on how much and what kind of food is available? Thank you in advance.

  15. Hi Paul

    I understand how much time this must take to answer all these questions so I am slow to ask but I am worried.

    I seem to be caught between a rock and a hard place. I get very bad brain fog that gets worse on eating and better when fasted. I would try a keto diet but any red meat I eat causes me to bloat up and be constipated. The same goes for any form of saturated fat such as coconut oil/milk which in particular makes my seborrhoeic dermatitis worse. My complicating issues are long term adrenal fatigue. It sounds like I could have a mix of things. What would you advise?

    I can be tested for parasites but docters wont test or proscribe anti biotics for infections in the UK. It seems like an area they are not concerned with.

  16. Hi Paul,

    This diet is completely new to me. Previously I was drawn to WAPF and GAPS but I always felt uneasy about the carbs issue- low/high… particularly for my little children and for pregnancy and lactation. SO your diet is like a breath of fresh air.
    Can you can give more advice on: diet for pregnancy/lactation/small children/weaning babies etc.. This would be so useful.
    Many thanks.

    • Also, what about intermittent fasting for this group?

      • Intermittent fasting is good, if you are well nourished it won’t interfere with milk production. One key is eating in the daytime.

        • Ok. That’s good to know. I may try it then (during lent :-)). I’ve not ever had milk production problems so should be OK. What about children? I’m assuming they shouldn’t fast and not in pregnancy either?

    • Hi Claire,

      as it happens I’m doing a webinar today on nutrition for nursing mothers, to a group of lactation consultants. I can share some notes from that. Maybe it should be a blog post.

      • Great. I would love the notes! Please do share. It would be so useful. I’m panicking now that i’ve been unintentionally too low carb over the last couple of years.
        Do you have more info about what children should eat? And in particular babies. I’m assuming a starch would be necessary for a baby (I’m still breastfeeding one who is starting solids)

        • Hi Claire. You really need to read the book if you have not done so already. It is life changing. I have successfully breastfed (2 kiddos) for the last year and a half on PHD (mostly). Never any problems with supply and my kids are super healthy (and brilliant). The milk is actually more nourishing. I know this because when i am 100 percent PHD, they nurse less, sleep better and are just happier. There is no healthier way to eat or feed your babies. The weight loss is slower than low carb but so much more fulfilling because of all of the added health benefits. Good luck!

          • Thanks Meg.
            I have no doubt it’s very healthy. It is very similar to the diet I’ve had just that it has the addition of starches. This makes it so much more balanced. Fortunately I’ve never had issues with milk supply even before I started eating natural food.

            What did you feed your baby once introducing solids? Did you just give them the same as PHD including white rice? Or did you focus more on some foods and less on others?

        • Paul,
          I would love to hear the info from the webinar also!

  17. Hello Paul! I’m new to the site. Recently saw your presentation at paleocon and found it very interesting. I have rosacea/acne and after having food panel testing done found out I have leaky gut as well. The only foods I tested ok for are vegetables, fruits, chicken, sole, halibut, almond, hazelnut, and coconut! The test showed I was allergic to beef and highly reactive to eggs and dairy and most shellfish/fish, which are important on your diet. Is the blood test accurate for food sensitivities/allergies? Should I avoid these foods? Any advice would be greatly appreciated. Thank you!

  18. Hey guys, love the book! I am currently working my way thru it a second time after working in many of the larger principles laid out in the book over 4-5 months. This time I am studying it like a textbook and taking diligent notes on much of it.

    I have one question regarding peanuts/peanut butter. I am having a hard time finding specific information as to why it’s so bad, granted, I am a peanut butter fanatic and am willing to cut it out but the scientist in me needs to know why it ranks so poorly. What I can find is that it is a bit higher in PUFa but contains more MUFa than any other fat. I also see that it is almost completely an omega-6 Fa but that could be factored in if the rest of the diet is low in omega 6 and some more is needed to bring in the right 6/3 balance… Yes, I’m looking for a way to justify it but I also will follow the facts!

    • There is an experiment cited in which monkeys get atherosclerosis and heart attacks when fed peanut oil (butter is mostly oil) but not tree nut oil. So cashew butter or almond butter would be better than peanut butter. Basic rationale — grassland seeds (peanuts/legumes) fed on by herbivorous mammals, tree seeds (nuts) fed on by wider array of animals and have less specific toxins and rely more on hard shells than toxins.

  19. Hello!
    Hi Claire (and Paul!)…I am a holistic psychiatrist specialized in perinatal health – women before during and after pregnancy. I worked through low carb ketogenic diets (based on psychiatric literature supporting their indication) and arrived at a version of the PHD in my practice and personally even before reading the book (which I now recommend to all patients). I would recommend prioritization of grass fed beef liver (food, desiccated, or capsules), bone broths, particularly saturated fats (coconut oil, ghee, pastured animal products), and fermented foods with generous resistant starches to avoid interfering with thyroid function and breast milk supply. Since everyone tolerates carbs differently, I monitor markers of insulin resistance (HgA1C, fasting insulin, glucose) to assess after initiating a basic PHD recommendation plan. All the best!

    • Thanks Kelly. What do you mean by resistant starches?
      I do eat chicken liver (as I find it the tastiest of all livers) but I struggle with other livers. I’ll have to find recipes to have tasty beef liver. The funny thing is, in my last pregnancy I ate more natural nutrient dense food than ever before. 2 to 4 egg yolks per day and chicken liver at least weekly. Broths daily, fermented foods, I love fats like butter and coconut oil etc… but this baby has a lip tie between her top front teeth. Apparently this indicates midline issues linked to not enough folate/folic acid? And the baby has crowded bottom teeth. How can this be? My previous children don’t have a lip tie and their teeth are less crowded but my diet was terrible (e.g. hardly ever ate liver, lower fat intake etc…). I just don’t understand. Unless it was all related to a few weeks at the beginning of pregnancy where nausea prevented me from eating enough 🙁
      Paul/Kelly, any ideas why this happened?

      • Claire,

        More than you ever want to know about resistant starch here


        • This is a wild guess, but perhaps even though you were eating all that nutrient dense foods you were not absorbing certain nutrients or had an otherwise malfunctioning gut due to lack of certain microbiota caused by being too low carb, or not enough of the right carb such as the once containing resistant starch and soluble fibers. Those feed the multiplicity of bacteria in your gut. Without them you get imbalances which may only up in subtle ways at first.

          • Thanks. I had no idea that starch can be good. I sort of thought of it as feeding the bad bacteria (which I thought I had) but it seems that without starch I would be starving the good bacteria I have? I hope I’ve understood that correctly. Anyway I’ve started to eat more rice and potatoes since yesterday, so I’ll see how it goes! 🙂

        • This is completely new to me! We’re meant to be eating raw cold starch? I’ve never heard this before. Did any traditional cultures do this?

          • You need to read the book. 🙂

            the safe starches that PHD advocates ( potatoes, rice, taro, yucca) all have some resistant starch in them. Traditional cultures ate all kinds of roots and other foods and many of them consumed quite a lot of resistant starch.

            When you cool those safe starches after cooking, more resistant starch is formed. So cook up more than you would eat at one meal, refrigerate the rest and reheat or eat as a rice or potato salad.

            Th raw potato starch is considered a supplement for those who may need more than they are getting from
            Food…but Paul has not said much about supplementing with the starch. The basic PHD diet concentrates on getting enough starch from food. I just linked to all those posts so you could read about all the benefits of it and understand a bit about why you need it.

            And yes, by not eating any starch you are starving all the bacteria and then that creates an alkaline environment that enables to bad bacteria to repopulate and take over. Whereas the proper acidic colon supports the good bacteria and when they are healthy and thriving they can keep the bad guys in their place

          • Thanks Ellen, yes i will have to read the book. It’s my next book to read 🙂

            Why then do some people find white potatoes constipating for example?

            What about the GAPS diet which is low in starch. It’s meant to be healing the gut and rebalancing gut flora. It has helped so many people 😕

          • Claire

            Our microbiome is vast, we probably know less about it than we do about the universe. And we are each as different as snowflakes.

            It is a new field of study. Don’t expect hard and fast one size fits all answers. Read, experiment carefully. Keep an open mind. It is a moving target.

            If you read all the stuff over a free the animal, including the comments, you will see that though there are many common results there are also a number who do not respond the same way. One thing that seems to help some of them to get the benefits of resistant starch taking one of the soil based probiotics and following the advice of
            Grace at AnimalPharm….see her series on SIBO

            Our guts can be messed up in many ways.

    • i have found venison liver to be good to eat, do you know if it has the same benifits as beef liver? thks alfred

  20. I am new to Paleo and your book, which I have read but really have a hard time applying to my situation. I am suffering from and being treated for fairly severe adrenal fatigue. As a result of this fatigue I have gained an incredible amount of weight which disturbs me to the point of depression at times and limits what I can do. Complicating everything is the fact that I have been a severe insomniac for almost 20 years (the results of numerous stresses in my life that are no longer there but the effects of years of stress are the adrenal fatigue and insomnia). I can’t seem to get a handle on how to deal with these three items. It seems the advice for weight loss is contrary to the advice for adrenal fatigue. It also seems that I will not achieve success over adrenal fatigue or weight loss until I sleep but that sleep continues to elude me (and I have tried virtually every piece of advice ever given by anyone; I am now trying HRT which is sort of working but actually only making me realize how tired I am and how much sleep I need). So while I am desperate to lose weight I have to deal with the adrenal fatigue and somehow conquer my insomnia. I have been trying low carb paleo for a couple of months–not too low but trying to stay below 50 grams a day. I feel pretty good on this but haven’t lost weight and it hasn’t helped my insomnia. If I increase the carbs I just gain weight–nothing positive happens. Have you any advice as to how I tackle this combination of issues?

  21. Hi,

    I’ve manged to clear so many of my problems with this diet – bloating, IBS, acne etc. but wondered if anyone could shed light on excessive sweating? I think it must be to do with neurological issues as I sweat profusely when the slightest bit of stress comes my way. It is especially noticeable in socail situations.

    On an interesting side note (and a bit of an embarassing one!) I have managed to cure the acrid smell by using lavendar oil and bicarb only for a deodorant. It seems the toxins in the commercial ones make it worse.

    Many thanks for anyone’s input.

  22. Hi,

    I’ve managed to clear so many of my problems with this diet – bloating, IBS, acne etc. but wondered if anyone could shed light on excessive sweating? I think it must be to do with neurological issues as I sweat profusely when the slightest bit of stress comes my way. It is especially noticeable in social situations.

    On an interesting side note (and a bit of an embarassing one!) I have managed to cure the acrid smell by using lavendar oil and bicarb only for a deodorant. It seems the toxins in the commercial ones make it worse.

    Many thanks for anyone’s input.

  23. HI Paul,
    I have my family on the Perfect Health Diet. Not 100% on supplements yet, but gradually working on this. Anyway, I don’t know if you can help me with this but I’m giving it a shot. My son is 15 and is balding very quickly. It is hereditary but I feel bad for him..he is so young and having a difficult time with it. Is there anything you can think of that would slow it down or help in anyway? I appreciate any input. thanks.

  24. I hope you don’t mind me asking another question before I get my hands on the book.
    Is there any information about the PHD and children? i.e. are the same foods suitable for them? Am I right to assume intermittent fasting is not for children? Any tips about this diet/lifestyle and children?
    I’m also interested in baby weaning diet. What starch is best for a baby? Would the WAPF weaning diet be suitable?
    Thank you 🙂

  25. Hello Paul and fellow readers,
    I am new to your site and am currently reading your book. I have been following a paleo type diet for at least 6 months because of leaky gut, yeast overgrowth, and poor good gut bacteria that was diagnosed from blood and stool testing. I have had improvements in symptoms but still have moderate acne/rosacea and keep losing weight even though I am skinny and have no weight to lose. However when I increase calories and carb intake, I notice my sinuses start acting up, get headaches and brain fog which I’m guessing is because I’m “feeding” the yeast. How do I kill of the yeast and eat enough to gain weight?

  26. Wondering if Paul or anyone here has any suggestions for me.

    My eyebrows ( and eyelashes but especially brows ) have gotten very thin.

    I am wondering if that is indicative of some kind of deficient? I have been off gluten for about 6 months and besides somewhat frequent allergic face rashes/eczema am in good shape/health.

    Also on another note does anyone know if its possible to be allergic/react to radishes but not other veggies in the same family?

    Had a definite reaction to something the other night and am trying to isolate it.

    Thanks in advance!

    • Hi Anne,

      Here’s my two cents. I’ve heard that thinning eyebrows is a sign of low thyroid. Anyone else?

      • yes, i have heard/read similar…

        but it seems to apply to the outer third of the eyebrows (not sure about eyelashes tho).

        so Anne, if it is just the outsides of your eyebrows that are thinning, then this may apply to you.

        ‘thinning or missing the outer third of the eyebrow is one symptom of hypothyroidism’

        & i guess the worse it is the longer you have been hypothyroid.

        • Thanks Ginny and gang!
          Really glad you suggested Low Thyroid, as when I look around at symptoms etc- I have a feeling that is it. I had slightly low T3 before stopping gluten and think it improved after, but recently had surgery which kept me from exercising as normal, I also have been eating raw spinach and kale chopped up and added to meals and for sure not getting enough carbs, all of which appear to be bad for thyroid… not to mention my mom has dealt with thyroid issues..
          I am still confused about the carb connection (good or bad for low thyroid/hashimoto) here though so if anyone has experience w/ boosting thyroid function naturally (Paul? (: ) with diet, supplements etc I am all ears and will get retested asap…
          Thanks Everyone!

          • …especially interested in what vegetables I SHOULD eat if I actually need to avoid kale, spinach, broccoli etc…
            or if they really are safe cooked? I eat a LOT of those…

    • hi Anne, i have been on PHD for 12 months now.
      i had lost the outer third of my eyebrows.
      about 2 months ago they started to grow back and continue to thicken.
      i have also lost the white scaly scin on my khees/elbows and a white fungus on my toe nails.
      i cant point to any particular part of the diet that could be responsible because i follow everything in the book including supliments,bone broth,saurkraut,apple cyder viniger,resistant starch and 16 hour fasting

  27. Hi, does anybody have any suggestions for foods to eat (or avoid) to help with symptoms of menopause, such as hot flashes.
    Thank You.

  28. Hi Paul,

    I love the book! Have been following the diet for around a year now with good results.

    I have a question about your recommendations for glaucoma, I have not seen you mention anything on your book or website about it. I have had this since i was around 15 (found high eye pressures) and have been taking eye drops ever since (i am now 25).

    I would like to eventually get off the eye drops as they do have some side effects and i was wonder if you had any ideas on the cause of this illness and some treatment recommendations. I am like you and think that the cause of this was likely some sort of deficiency when i was younger (ie. omega 3, vitamin a).

    From my reading online it seems i should:
    – take vitamin c / b12 / magnesium / vitamin a
    – control my blood sugar
    – increase intake of omega 3

    Hopefully you will be able to help a bit, as doctors are content on eyedrops and surgery in the future.

    Many thanks,


  29. How often should we intermittent fast?

  30. Hello there,

    My question is around headaches. I have been following perfect health diet for a month with good results, lost 7 pounds, I’m less hungry and I have days when I feel amazing, full of energy, not thinking of food at all. However in the last few weeks I have been experiencing headaches that last all day. It happens at least once a week. I never used to have headaches.
    I have been eating carbs, I don’t think it’s the lack of carbs. For example today , I had a banana w cheese for breakfast , salmon/rice/brocolli for lunch and then around 3 pm my headache started and lasted all day. I tried having a banana at 3, it did not help.
    Once the headache starts it does not seem to go away unless I eat a lot of food and take a nap.
    I was wondering if the headaches could be due to hypoglycemia. Every time I started a low carb diet I used to get these type of headaches and I used to quit the diets after 2 or so weeks.
    Any advice would be greatly appreciated. Thank you Laura

  31. Hi Paul, can you give me in few words why Saturated fat is a better choice than Olive Oil lets say?

    Is the main reason because Olive Oil is higher in Omega 6s? But then what about Macadamia oil?

    Or is it all about medium-chain fatty acids that support the immune system?


  32. Paul, what is your view on raw Manuka honey? Is it a good probiotic?

  33. If you can’t buy naturally raised/grassed fed liver in your area….do you buy what is available or would you just supplement with copper?

  34. Hi Paul, thanks for reading, I appreciate the time you take for your readers it must take awhile. I’m a pretty healthy 27 year old guy, long time paleo, a month on PHD, but I’ve still got an issue with stomach distention. I’ve been to several gastroenterologists and none have wanted to do any diagnostics, craziness.

    You once suggested a metametrix stool sample test which I need to do. What other tests for general gut dysbiosis would you suggest? I know there’s the bloodwork, and I also did the hygrogen methane breath test (using only lactulose, they couldn’t do the other sugars) to check for sibo, was negative, celiac, thyroid both negative. Ideas?

  35. Hi Paul, thanks for reading, I appreciate the time you take for your readers it must take awhile. I’m a pretty healthy 27 year old guy, long time paleo, a month on PHD but I’ve still got an issue with stomach distention. I’ve been to several gastroenterologists and none have wanted to do any diagnostics, craziness.

    You once suggested a metametrix stool sample test which I need to do. What other tests for general gut dysbiosis would you suggest? I know there’s the bloodwork, and I also did the hygrogen methane breath test (using only lactulose, they couldn’t do the other sugars) to check for sibo, was negative, celiac, thyroid both negative. Ideas?

  36. Hi Paul,
    I bought your book via your link but while I wait for it to arrive and before I read it all I was wondering if you could give me a tip so I can get going with the diet.
    I’ve started the intermittent fasting today and working on the circadian rhythm. I’m eating quite similar to PHD for 2 years but last week I’ve added in more rice and potatoes. Prior, I’ve only had them weekly.
    I am breastfeeding. My main symptoms are:
    -Bloating (this seems worse over last few days that I’ve started eating more rice and potatoes).
    -And I have a mild pain in the lower left side of my tummy (this too has only started a few days ago- but I’ve had similar 6 months ago).
    -Prone to constipation (seems a little better I think since adding safe starches)
    -Occasional headaches (every couple of weeks perhaps)
    -Occasional nausea (every month or two)
    -BO- comes on with very mild stress
    -poor skin-mild acne spots

    I’ve started the intermittent fasting and working on the circadian rhythm. Not too sure why I’m so bloated though. Any other tip before I find out more in the book? Would be greatly appreciated. I’m worried about the bloating feeling.

  37. Hi, any tips specifically for diverticulitis?

  38. What are your thoughts on the best diet for PCOS? My doc is thinking I should be tested for it. I am not overweight, but I have irregular or non-existent periods (they first went when i had an eating disorder but even now i am healthy weight they have gone again) and I also have dark hair where it shouldn’t be! Everyone seems to say low carb for PCOS. But I have just been adding back in carbs as per your advice! My hair, energy, bowel movements and eye moisture has improved with more carbs. However, my ability to endure long periods of time with no food has worsened, which makes me think of insulin issues. Any thoughts?

    • I’m curious about this too. My doc diagnosed me with PCOS and put me on a diabetic drug. Before taking the drug, I had no problem with IF. Now, I am extremely hungry in the morning and am light-headed during exercise.

  39. Hi there,

    For anyone following PHD, low protein (15% protein?) would some be willing to share with me what a days meal might look like? I’m not sure if 15% protein means a palm size amount of animal meat per day or more than that.

    I am allergic to eggs and nuts, sadly. I also have issues digesting fats (I take enzymes) and am not looking to loose weight.

    Thanks for any help!

  40. Hello,

    My wife is Korean and I would love to find some articles in Korean about the dangers of vegetable seed oils and wheat. Specifically their toxicity.

    I wondered if Shou-Ching might know of any since she can speak Korean and grew up in Korea.

    Thank you.

  41. Hi Paul,
    I have RA autoimmune disease (no meds), more recently have developed inflammation in my mouth (feels as if my mouth/lips are scalded permanently)
    Also some hypothyroid symptoms.
    I had been happily eating within 8hr period but I know you stress, if well intermittent fasting is a good idea.
    So thought I would concentrate on eating lots and often for a while to ensure well nourished. As low body temperature too.
    It seems that concensus of opinion of folks who disagree about somethings all agree that polyunsaturated fats are inflammatory.
    I would appreciate your opinion on eating avocadoes? I eat a couple of brazil nuts daily for selenium and occasional almond butter. Wild salmon once per wk. So thought I wasn’t over doing it but I do eat an avocado daily, relying on as find filling (replacing bread etc.
    In your book you mention avocado oil as being over 80% mono/sat fat and so thought no need to be concerned re polyunsaturated amount. As all food has variable amounts of all fats and seemed a good ratio.
    However I notice Ray Peat states to avoid avocado completely re polyunsaturated fat but then he states to avoid berries re the seeds which seems extreme.
    I have relied on avocadoes as a staple since starting the PHDiet and don’t want to become negative food obsessed but clearly something isn’t working.

    • Have you considered a fungal infection? If it is a fungal infection, then a ketogenic diet would not be a good idea.

  42. Hello Paul,

    I was wondering what your approach is with Pacific Seafood after Fukushima. I’m nervous about eating Alaskan salmon and any seafood off the California coast. I live in L.A. What are your thoughts on this? Are you aware of a scientific consensus on the levels and dangers of the radiation?

    Thanks for your time, as always,

    Nick 😎

  43. Dear Paul,

    I’ve searched your website for any info of bladder issues, but I have not found anything that seems helpful. I’m therefore hoping you’ll have time to answer my post!

    I’m a 30 yo female, and I have a chronic inflammation in my bladder (not diagnosed as IC by my doctor as there is no scar tissue). This causes me pain on a daily basis, and I have almost weekly flairs where I think I have a UTI, but tests come up negative. I’m nonetheless suspicious that there is bacteria or something else involved. I just don’t know how to get to it! It’s been going on for maybe 5 years, and I’m starting to go a bit crazy…

    I’m wondering if you have any advice in terms of supplements etc that might help rebuild or coat the wall of my bladder, or calm the inflammation? I’m eating PHD since about mid January. Other health issues include eczema (slightly worse since I started PHD) and quite sever fatigue. I also have quite dry eyes…

    Many thanks for your help and time!

    All the best,


    • Hi M,

      Some keys are liver and spinach (vitamin A), vitamin D, vitamin C, zinc, iodine, circadian rhythm entrainment (exercise, intermittent fasting, bright natural lights in day and dim amber lights at night), and eating fermented vegetables to improve the gut flora. You can consider washing your genitals with the juice from fermented vegetables to try to get some bacterial diversity into the urinary tract.

      Dry eyes suggest you may be too low carb, or deficient in vitamin C, omega-3 fats, or phospholipids.

      • Hi Paul,

        Thanks for your reply. I’ll up my spinach and liver and see how I go. I’m already in process of implementing most of the things you suggest, but I’m curious, how would you become deficient in phospholipids?

        I don’t think I’m too low carb, and I take 1g of vitamin C every day, and I eat salmon every week.

        Can this have something to do with chronic inflammation oxidising the omega 6?

        Thanks you!


  44. Hi M, I too suffered from recurrent bladder infections often twice per month followed by thrush.
    If not twice, then once per month. Ended up on continuous prophylactic antibiotics. Had bladder emptying checks at the hospital, and two appointments over the years of having a camera inside the bladder.
    Then after 35 yrs of suffering I found D-Mannose and wild oregano oil.
    Any slight sign of even possible irritation – I took D-Mannose and rubbed oregano oil on my skin (nearest to the bladder around the pubic line) I also rubbed on the base of my spine.
    I continued for a couple of days even though the irritation disappeared almost instantly.
    I also always took a spoonful of D-Mannose in a glass of water before and after sex. Don’t seem to have a problem now (touch wood!) but would never not have any D-Mannose or oregano oil in the house. It is my safety net – I know I do not have to panic as it is to hand and works, so no more rushing to the phone to grab an appointment with the doctor.
    D-Mannose is a simple sugar that is not absorbed into the blood stream but is passed directly into the bladder and out through the urine. A teasp diluted in a small glass of water – tastes a little sweet.
    I am in the UK and purchase from http://www.naturesupplies.co.uk read the informative articles on the site then find a stockist in your country.
    Good Luck

    • Hi Lynne,

      Thanks for taking the time to reply. I’ve had mixed results from D-mannose, but I’ve never tried oregano oil, so I’ll give that a go. Now I would just need to work something out that fixes the chronic inflammation as well! But maybe one day… 🙂

      • Hi, That’s ok, I know what sufferers go through. See if you can get a copy of the book ‘The Cure is in the Cupboard’ Dr Cass Ingram – re oregano oil. 🙂

  45. Hi, Paul –

    The following article hit the press today:

    Have you had a chance to look at the research – any opinions?



    • Hi Jim,

      I took a quick look at the paper. On the one hand it’s not surprising based on animal studies that high protein (> 20% calories) might shorten lifespan a bit. On the other hand the new data from them is not very impressive. It’s from NHANES and they have models with all sorts of adjustment factors to generate their results, and the effects of protein reverse, the protein looks negative at ages below 65 and beneficial above 65, but I bet if you changed the adjustment factors, you could totally change the outcome. Also, it’s barely statistically significant. It looks a lot like data mining to me.

      The mouse data looks plausible. And the small subset of humans from which they had IGF-1 data is interesting. It probably should have been three papers, but they got it into a high impact journal by stitching everything together.

  46. Hello Paul,

    I wonder if you can comment this article found on a “pro-ray-peat” blog.


    It seems it claims the opposite of the PHD style… I’m convinced by my daily PHD practice due to the improvment so shortly gained. Anyway on a long term basis, could you please give us some keys to re-think this article on a PHD point of view ? I mean : what about IF ? what about the “right” moment to eat carbs without gaining weight ?(better on the last meal or..?) what about coffee ? and so on…
    Thanks a lot Paul !

    Best, Pénélope

  47. I have been mostly Primal for last 6-8 months. I have hypothyroidism and have not been losing any weight. I read your book and it all makes good sense, but I noticed your emphasis on eating egg yolks. I have a tested, true and severe egg intolerance.
    Do you have any suggestions for egg yolk substitution from the weight loss portion of your book?
    Thank you for all the valuable information you have provided!

  48. Hi Paul/everyone,

    Could you advise in regards to Coconut Sugar – I have found a great gluten free recipe which uses this instead of sugar.


  49. Hi everyone,
    I’m not sure if this is post-worthy, but it occurred to me that it might be something to share. I have been wheat-free for 20 years and before PHD took the recommended 1500 mg of calcium/mag, boron, etc., along with plenty of vit D. Since early 2012 I have followed PHD supplements, mostly, and have taken no added calcium outside of my food.

    Yesterday, I attended a morning workshop in a neighboring community, leaving my colleagues to deal with the turmoil of yet another busy day in the counseling office of a local jr. high school. I enjoyed the workshop enough that I felt guilty at having left my colleagues, so stopped at the food co-op to pick up some Whidbey Island ice cream bars to take back. I was rushing and parked where I don’t usually park, and an unseen slight ridge in the concrete grabbed my toe and, struggle as I did, I could not right myself before face-planting on the hard sidewalk. Scraped one knuckle of one hand, floor-burned the heel of the other hand, a scrape on one knee, and bent and scraped my glasses pretty badly. I am a grandma to teenagers and I think odds would have predicted that a fall like that would have broken something beyond my pride. But, I popped up, grabbed the ice cream bars, swung by the optician for a temporary repair until I get new glasses, and back to school, where the ice cream was much appreciated. Ice on the knee, and I’m doing well this morning.

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