Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. hi Paul,
    what do you think of buttermilk, for drinking not cooking. & the stuff commonly sold in supermarkets, ie. pasteurised & homogenised?

    this product is cultured milk, cultured with either Lactococcus lactis or Lactobacillus bulgaricus (ref Wiki).
    This milk will be higher in lactic acid acid than normal milk (similar to yoghurt or sour cream at a guess?).

    so, what do you think, is it ‘PHD’. is commercial buttermilk ok…?
    Is consuming lactic acid ok…?

    happy days, Darrin

    • buttermilk update:
      well it passes the taste test,
      tastes like ‘no-added sugar drinking yoghurt’,
      not surprising i guess, since the ingredients list is milk & culture.

      • You know what I am curious about? When my mother describes what buttermilk was before it came in grocery store cartons — when her mother had her do the churning — it sounds like a completely different thing from what commercial buttermilk must be. (Cultured milk? Sounds loosely akin to kefir.)

        I think she said Grandma would leave out the milk a day or two after milking, then they would churn the risen cream, and the buttermilk was what was left in the churn?

        So I wonder what that tasted like and what its nutritional benefits where — in contrast to the thing they sell in cartons now labelled “buttermilk.”

        I should ask Mama to go over those facts again for me. (I do have Grandma’s churn….)

        • yep, its not ‘real/traditional’ buttermilk. which is why i mentioned supermarkets.

          the ‘original’ buttermilk is “the liquid left behind after churning butter out of cream” source wiki http://en.wikipedia.org/wiki/Buttermilk

          i view the stuff i bought from the supermarket as ‘drinking yoghurt’ but sold at a cheaper price than the stuff labelled drinking yoghurt/biomilk/cultured milk.

  2. Hello! Quick question about winter squashes such as acorn and butternut and other starchy veggies such as parsnips or rutabagas. Are these counted in with starches for carb calories or in with sugary vegetables? Is there a magic number say over 15g carbs/100g count and under don’t? Thanks!

    • I’d like to understand more about this, as well.

      I do know one thing. When I was following the “Specific Carbs Diet” (which strictly excluded every starch), butternut and acorn squash were permitted. Parsnips and rutabagas were not.

      SCD was about the molecular structure of the carb. Polysaccharides were the demonized type (starchy). Butternut and acorn squash are monosaccharides, they said, easier for the intestines. With polysaccharides, the intestines must split the molecule apart to digest them.

  3. As a newbie, I’m very unskilled at quantifying my diet. Can you recommend a website which provides tools for maintaining a personal diet diary that will allow me to make the adustments so that I can achieve the various nutrient/food goals that you recommend. I can recall from your book using a closed fist as a measurement aid, but would prefer a more precise method.

  4. Hi Paul,
    We’ve started implementing you recommendations of safe starch from a previously GAPS type diet, which was very similar as we were not that strict and did include some non GAPS foods such as potatoes. However, since we started eating more potatoes and also rice my 5 year old has developed burping and what I think could be acid reflux as she says food sometimes comes back into her throat. What could this mean? Is this some kind of bacterial overgrowth that has been fed by the extra starch? I am concerned and not sure what to do or what test to try.
    Any advice would be much appreciated.
    Thank you.

    P.s. I am currently reading through my recently acquired PHD book.

  5. Hi Paul,

    I am a 21yo male who has experienced a severe decline in health despite previously being a very healthy, high-performing college student. Almost 3 years ago, I developed a chronic illness consisting of neurological (most notably extreme brain fog and fatigue), GI (bloating/constipation/very slow transit time), hormonal (low T3/secondary low testosterone/dysregulated cortisol) and metabolic problems (postprandial fatigue/body temp ~95/resting HR in 40s/low BP)as a result of some combination of disease and environmental toxins (possible Lyme disease/impaired detoxification pathways/high mercury levels/mold exposure/possible fungal overgrowth. I have already tried many different treatments, none of which provided a lasting improvement in my condition. My doctors continue to try different approaches such as antibiotics and detoxification therapies, but so far my responses have only been negative. In the mean time, I have recently begun my own version of a strict ketogenic GAPS diet. This diet consists of:

    65-70% calories from fat (mostly as MCT and coconut oil, also some macadamia oil and fermented grass-fed heavy cream)
    25-30% calories from protein (easily digestible unsweetened protein as gelatin, hydrolyzed whey protein, pea protein isolate, colostrum powder and some raw grass-fed lean beef)
    <5% calories from carbs (as well-cooked broccoli/cauliflower and leafy greens)
    Additional added trace minerals and micronutrients

    I puree all of these ingredients together and consume it as 3 meals.

    I have experienced some subjective benefit since starting this diet 1 week ago, which includes noticeable improvement in energy. I would like to continue with this diet as I try to heal my medical problems, as I feel that it is probably best for neuroprotection and gut healing. However, I learned from your writing that ketogenic diets should not be used by people with fungal infections, because they can feed the fungus and cause systemic invasion. Based on my symptoms and response to different medications and supplements, my doctor and I think that I likely have some form candidiasis or other fungal infection. Thus, a ketogenic diet would be contraindicated based on your advice. Also, I already have low T3, metabolic damage (low HR/low BP/low body temp) and "adrenal fatigue" symptoms, which could theoretically worsen on a VLC diet. In my case, I think that this version of a ketogenic diet is one of the few things that has provided any significant benefit on energy levels, and I would like to stay on it if possible. However, I have noticed that my heart rate got even slower (low 40s) and body temperature decreased even more since eliminating carbs from my diet. I tried adding dextrose to the food mixture per your recommendation of including some carbohydrates in a ketogenic diet, but this caused postprandial fatigue and counteracted some of the stabilization in energy that I see from the diet without any carbs. Thus, I reverted to consuming <15g of non-fiber carbs per day.

    If I do have candida or fungal infections, do you think it would still be possible to get rid of them while I am still on this diet? Are there any specific adjustments I can make to help eliminate fungal overgrowth while I am on a ketogenic diet? Also, do you think it would be possible to work on improving my thyroid and adrenal function while on this diet, even though a VLC diet generally exacerbates these conditions?

    Thanks so much for your time. By the way, your website and book have been one of the only resources that provided any beneficial advice to me so far, so thank you for all that you are doing.


    • Hi Alex,
      Paul has a few articles where he discusses fungal infections; you might find them helpful. You likely already did this but in the google search bar on the home page, type in fungal infections. Also, Paul has done a podcast over on Chris Kresser’s website where he discusses chronic infections (fungal included). Here is the link https://chriskresser.com/episode-15-dr-paul-jaminet-on-chronic-infections-depression-more. Chris Kresser also has a few discussions on fungal infections. Best of luck with your healing endeavors.

      • Hi Steph,
        Thanks for the reply. I saw the places where Paul discusses fungal infections, and I did find his advice helpful. However, it seems like he just states that people with fungal infections should not follow ketogenic diets, because fungi and protozoa can use ketones for energy. His advice is very clear and makes sense, but I wanted to find out if there is any way that I could treat a fungal infection while on a ketogenic diet, since I’m using the ketogenic diet for neuroprotection and blood sugar regulation issues. Maybe there’s no way of avoiding the negative effects of a ketogenic diet and I have no choice but to include carbs in my diet, but I wanted to find out for sure.

        Also, I just found out that I probably have SIBO, as my doctor put me on rifaximin and it seems to have helped some of my symptoms. This means that I need to avoid fermentable carbohydrates and fiber in order to prevent SIBO. If I don’t use a ketogenic diet, I must get all of my carbs from high-glycemic starch or simple sugars, which tends to make my hypoglycemia symptoms and postprandial fatigue worse. However, a ketogenic diet exacerbates my hypothyroid and adrenal symptoms and may also feed fungal infections, so I’m not sure what to do.

  6. hi Paul, I enjoy drinking the coconut water out of a fresh coconut, and scraping off and eating the white coconut flesh inside. Is it ok for me to have one standard size coconut everyday, or is that too much? thank you

  7. Hi Paul. I hope you can answer this question. Thank you so much, firstly, for all of your great material. My wife and I love your book and have benefited greatly from your work. So, my wife and I are trying to get pregnant and we’ve scoured all known Paleo sources for the best information on fertility, optimized pregnancy, and healthy babies. One thing we keep coming up against is our necessity of having a Cecesarian Section, which is highly discouraged by most for a variety of reasons. For us, it is a medical necessity due to uteran scar tissue after fibroid removal. Our question is, how can we optimize a c-section birth? Are there any alternative approaches to populate the child’s gut/colon with helpful bacteria that he or she will not get due to the avoidance of a vaginal birth? What can we do to make sure our baby is as healthy as possible? Thank you so much if you can answer this.
    Patrick and Elaine

    I would also like to thank you specifically for recommendations for my night terrors. I was too low carb and waking up with violent night terrors and movements. They have subsided and I sleep oeaceful now by eating my necessary carbohydrates per your recommendation. Thanks!

    • Hi Patrick,

      Two sites that I have come across in the Paleo community regarding pregnancy have been by Chris Kresser and Dave Asprey. Not sure, if Paul agrees or is familar with the sites but I can speak to that. The two sites are http://healthybabycode.com/ and http://www.betterbabybook.com/

      • Cathy Fairbrother

        Firstly are you absolutely sure you cannot trial labour? Secondly I have 5 children and each one had reflux as an exclusively breastfed baby. With four of them I identified an offending food in my diet and cutting stopped their reflux. With my fifth child I identified casein as the culprit but a naturopath specialising in gut healing said almost all cases of reflux even when triggered by foods are because of unbalanced gut bacteria in baby. she proscribed a special probiotic for newborns. After finishing the course my baby never had reflux again and I could eat all the casein I wanted. New borns have different bacteria than older babies and toddlers and should avoid most other probiotics because of it she said. You can get it on Amazon or contact Bioceuticals and get a naturaopath or Doctor to order it. It will help colonise your babies gut after caeser. If possible avoid intraveneous antibiotics if you can too. Also read the chapter in the GAPS book on introducing solids to babies. I only asked about trial labour because there are women sho have had much scaring due to repetitive caesarians who have then had VBACs. Best of Luck. One of the best things you can do is exclusively breastfeed as baby gets probiotics in your milk. Baby will get antibiotics in your milk too oafter the caeser and may miss on the benefits of the colostrum because of it however Babybiotic will help. Natren also do a babies probiotic called Life Start but I was told Baby biotic was better.

        • Cathy, I wish I understood how people find such things as “a naturopath specializing in gut healing.” Do you mind telling what state you live in? I am in Tennessee, where I’m guessing our prevailing doctor establishment somehow controls the health marketplace in a way that makes natural healing practitioners almost impossible to find. And, we can apparently forget about natural/holistic MDs.

          • Cathy Fairbrother

            I don’t live in the states. Where I live Naturopaths are easy to track down. Some are better than others. I even used a paediatrician for my son who specialises in gut healing and biomedicine and she is certainly no quack. I have no idea about how to find someone where you live. Here one must pay privately. From what I’ve gleened there are non quacky people who also specialise in gut healing protocols in the USA. You may need to do some googling. Specific Carbohydrate Diet and Gut and Psychology Syndrome forums and web sites may point you in the right direction.

    • Patrick and Elaine,

      My husband and I have one child so far and are hoping for more healthy pregnancies and deliveries. What I plan to do if I ever need to deliver via C-section is get vaginal swabs taken and applied to the baby immediately after birth on the baby’s skin and mouth and nose and such. The idea is kind of gross but seems to be the best approximation of normal colonization. Since your C-sections will be planned, you’ll probably have plenty of time to find a cooperative OB and plan this in advance. As I would with any delivery, I’d put the baby skin-to-skin ASAP (on Patrick’s chest if the baby can’t go on Elaine yet) and not wash the baby off for a few hours, and then just try to use plain water. Talk to your OB about “delayed” cord clamping, too. Also, I’d go home from the hospital as soon as reasonably possible, since babies who spend less time in the hospital have less abnormal flora. Ther-biotic makes a high-quality infant probiotic. Whether and how much to use infant probiotics is a judgment call at this point (I don’t think we have enough research available), but if it were me, I would consider it in the case of C-section and definitely experiment with it if a baby showed allergic/sensitivity symptoms or had a course of antibiotics.

      You probably know a lot or all of the following recommendations: breastfeed, of course. Two years is the biologically normal minimum and four years is the human average. I grew up with a lactation consultant mother who breastfed her children 2.5-4 years, so for me this is normal and not weird or stressful and I have a great resource for when I have questions; see who you have in your life that can be a natural support system for that, if possible, because most mothers who want to breastfeed don’t end up doing so (I’m assuming you’re in the U.S.) and this seems to be due to poor support and unreasonable expectations as far as career lifestyles go. Elaine should eat as many naturally fermented foods as possible during both pregnancy and lactation, and fermented foods should be offered regularly to babies once they start eating solids.

      I highly recommend reading the book “An Epidemic of Absence” by Moises Velazquez-Manoff.

      I hope this helps! My best wishes for your family!

  8. Hello,
    Has anyone had a problem with very sudden weight gain after supplementing with iodine? Also, is it possible that iodine could exacerbate my chronic insomnia? I’m guessing that I either increased my dose too quickly, or maybe my two Brazil nuts per day is not providing adequate Selenium balance. Any thoughts on this would be very much appreciated!

    • In an April 2013 answer to someone’s iodine question in the comments to Paul’s “Latest Red Meat Scare” article, he told her that supplementing with iodine can induce hypothyroidism.

      Here, I’ll paste Paul’s comments:
      “…That does sound like hypothyroidism – maybe hyperthyroidism. It is probably excess iodine, possibly compounded by other items in the seaweed extract. That site doesn’t tell us the dose of iodine in a capsule but it might be large. Suddenly starting high doses of iodine often generates hypothyroidism.
      “I would drop that supplement immediately. If you want to take iodine, try buying the NOW Potassium with Iodide on our supplement recommendations page and cut it into quarters with a razor blade and try one quarter daily. Double the dose once a month and when you reach one tablet daily, stay there. That will be 225 mcg/day.”

      I’m trying to figure out what’s up with my thyroid, too. Best wishes–

  9. Hi Paul!
    I did a bad thing and ate lots of wheat all weekend, more than I have in the past couple years. Now, a few days later, I seem to be having very severe hypoglycemic responses after eating my lunches (for the past 3 days). I’ve started to keep a food diary today, to try and narrow down what is going on. Today I ate a mix of nuts with mostly coconut flakes for my breakfast and the leftovers for lunch and had that panicked foggy headed feeling almost immediately. I made myself eat some sheppard’s pie with white potatoes and felt a little better, but started feeling bad again an hour later. I do not monitor blood glucose at all, I am a 28 yo female and have over the past year and a half gained 40 pounds starting from a healthy weight. I’m not sure where to go from here. If there is any other info I need to give you, please let me know. I had been adding in the resistant starch in the form of potato starch, following the free the animal blog, but I started getting major skin flare ups with red, swollen, hot and itchy skin patches in random spots after starting that. I do take prescript assist now as well, which has helped my sense of well being a lot. Back in Dec and Jan I had to take azithromycin both months for bronchitis that wasn’t clearing on its own. Any advice or help would be great. I just feel so stuck.

    • Hi Kati,

      If you do have a food you know you’ll react to, I would personally take some activated charcoal tablets to help reduce the damage.
      If you’ve damaged your stomach from medication and wheat, I think Paul will agree, bone broth and fermented foods are recommended.

      As for white potatoes, I know Chris Kresser says to let them completely cool before eating them. I can’t remember the science behind it but that might be the reason you had a problem with them. If you react to potato starch, try tapioca flour, rice flour, eating sweet potato or white rice.

      Hope this helps.

  10. Hi Paul,
    I would be interested to hear (read) your comments on this study that was published last month, if you have full access to it. (or if you have commented on it previously, a link).

    Their Conclusion “…overeating SFA promotes hepatic and visceral fat storage whereas excess energy from PUFA may instead promote lean tissue in healthy humans.”

    Basically they were trying to compare Sunflower Oil (pufa) with Palm Oil (sfa) over 7 weeks.
    Some comments:
    – it was an overfeeding study (ate 750 extra calories per day for seven weeks).
    – the sfa came from palm oil, which i guess would have been a refined oil?
    – study only lasted 7 weeks.

    press release link: http://www.uu.se/en/media/press-release-document/?id=2240&area=3&typ=pm&na&lang=en

    • the Press release attention grabbing headline & first para,

      “Abdominal fat accumulation prevented by unsaturated fat”

      “New research from Uppsala University shows that saturated fat builds more fat and less muscle than polyunsaturated fat.
      This is the first study on humans to show that the fat composition of food not only influences cholesterol levels in the blood and the risk of cardiovascular disease but also determines where the fat will be stored in the body.
      The findings have recently been published in the American journal Diabetes.

    • I presume that they used palm kernel oil in this study & not palm fruit oil (red palm oil).
      In the abstract it is just referred to as palm oil, but since they were looking for a high sfa oil, kernel rather than fruit would make sense.
      May be it is defined better in the full text.

  11. Hello Paul,
    I have systemic yeast infection causing leaky gut, rosacea, sinus problems, etc. I have been following primal type diet and recently added in more starch, iodine, vitamin c as well as antifungals from reading your site and book. I think it’s helping, too soon to tell but I was curious on how you treated your rosacea. Did treating the yeast and following the diet improve your rosacea or was there anything else you had to do? I also read the post you did on rosacea and was curious if you recommend the weekly beef liverr, lb of fatty fish, or vitamin a supplementation for rosacea patients based on that information of EFA and A causing oxidative stress. Thank you so much for your time! Seriously appreciate it!

  12. I like your sincerity in your website/blog info and thus, my question goes to you. I have undiagnosed hypo (numbers good, but still pointing to a conversion problem), but I also have slight insulin resistance, moderate you would say, borderline and high cholesterol. So is a high sugar/carb diet for me, like Peat or a more moderate one?? How do I tackle all my health problems in one, since hypo requires more carbs not a low?? What kind of ratio sounds good to you and should it include starches or no? Just hoping for your opinion. tHanks

  13. Hoping you got my question

  14. Hey Paul,

    I suspect gut problems due to bloating and I don’t want to aggravate symptoms with fiber or resistant starches, so per your suggestion I’ve been eating dextrose instead of safe starches for my daily carb intake for the past 3 months.

    1. How much dextrose per meal do you think is too much? I’m trying to pack on muscle and I’ve been drinking lemonade after each meal (1/3rd cup dextrose + 1/2 squeezed lemon). Is 1/3cup per sitting too much? My symptoms haven’t seemed to improve since I started 3 months ago. Comes out to 1 cup dextrose/day or 768kcal, no other carbs consumed (just meat and supplements).

    2. Is it smart to limit my fiber only to fermented veggies and see if that helps with bloating?

    Thanks very much for reading.


  15. Hey Paul, I wanted to ask what your thoughts were on parasite cleansing and colon cleansing. Their are many products for sale made of green black walnut, wormwood, and cloves which allow parasites to be killed and later excreted in the stool. I was curious if you thought keeping up with some type of parasite cleanse or colon cleanse is necessary for optimal health or if following the guidelines of you diet (which I do)is enough to keep parasites at bay so they do not cause health problems. Thank you.

    • Hi John,

      I wouldn’t do it unless you have been diagnosed with a parasite.

      No, there’s no general need to colon cleanse. That’s what we have gut bacteria for.

      • I love it Paul, Thank you that is how I felt about the situation but it always helps to have my theories reinforced by a Great mind like you. Thank you for all you do your book is my go to for ANY health concept and I believe is second to none as far as health and nutrition books go. Thank you again.

  16. Paul, I took a small course of B. Clausii probiotics (enterogermina) prescribed by the doctor for my subpar digestion, and tiredness after meals. It made me feel worse overall, bloated and more propense to indigestion, and those effects lasted for a good while after I stopped taking the probiotics. I detected no benefits. What can this mean?

  17. Hi Paul. What’s your take on whether or not nightshade vegetable contribute to the development or worsening of arthritis in some individuals?

  18. Acid Reflux | Heartburn Gerd Blog - pingback on April 13, 2014 at 8:09 pm
  19. Hi Paul, I found great help here when I was having recurrent mastitis due to the increased fat in my new Perfect Health Diet whilst breastfeeding (the answer for me is a Lecithin supplement).

    Now I have another question. My husband’s entire family is on cholesterol medication, except him, although he is the oldest son (he’s also the healthiest and thinnest). We’ve been more or less following PHD for ~2 years, though my husband eats fruit and sweets at his workplace on a pretty regular basis. He walks about 3 miles per day commuting back and forth to work.

    At his workplace, a health check that recommended he get his cholesterol levels checked. He had a fasting blood test, with the following results (in Australian units):

    glucose 4.3 mmol/L
    cholesterol 7.3 mmol/L
    triglyceride 0.6 mmol/L
    HDL 1.3 mmol/L
    LDL 5.7 mmol/L

    The lab doctor’s comments said “Consider familial hypercholesterolemia when LDL > 4.9 mmol/L”

    What would you suggest?

    • Hi Elisa,

      That is high for LDL, you’d like 3.4; HDL could be a bit higher, but is normal; triglycerides great.

      You can read our “High LDL on Paleo” posts in the LDL/HDL category, http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/. Basically, this commonly indicates that he is too low carb and/or that he is hypothyroid or mineral deficient. I would eat more starches and carbs, supplement iodine 225 mcg/day, eat liver weekly, 3 egg yolks per day, supplement zinc, get sunshine daily, and work on circadian rhythm entrainment, intermittent fasting, and daily exercise.

      Best, Paul

  20. Paul, what can cause fasting hypoglycemia?

  21. Paul, is there enough research to show GLA from evening primrose oil is significant help for dermatitis?

  22. Isabel Guerreiro

    Dear Paul,

    I’ve just finished reading your book and I am seriously considering following your PHD. I don’t have weight concerns though I’d love to lose the 6 pounds I gained after giving birth to my twin daughters.

    I still have some questions regarding the food I can eat:

    – What about fruits? Can I eat them every day? If so what fruits, when and in which portions?

    – And nuts? Can I eat walnuts, hazelnuts, almonds, pecan nuts, cashews? Can I eat them with yoghurt?

    – What should i eat after exercise?

    – I might find difficult to have dinner around 6/7 pm (end of the day). If so should i have a full dinner even if it’s just 1 or 2 hours before sleeping or I should have a very light dinner (meat broth for example) and have a more substantial breakfast?

    Hope you can answer such an amount of questions.

    Best regards,

    • Hi Isabel,

      Yes, you can and should eat fruit every day. We recommend 2-3 pieces per day. They are an excellent dessert or snack. Generally later in the day is better for fruit. Some fruit or berries can be the last thing you eat in the day, as dessert after your last meal.

      Nuts are OK in moderation. There is a table of the omega-6 content of nuts in the book. You want to keep that down. It is best to use nuts as flavoring agents so yes, eating them with yogurt is excellent.

      You should eat a normal balanced meal after exercise. If the exercise was in the morning, emphasize protein.

      It is best to concentrate food intake around mid-day and the afternoon, and finish eating about 3 hours before bedtime, save for a dessert that you can have close to bedtime. If you have to eat dinner late, make it a light dinner or snack and make your lunch the largest meal. We recommend also eating only a light breakfast and pushing large food intake to the afternoon. Best is to do intermittent fasting, restricting eating to an eight hour window.

      Best, Paul

      • Wondering if you got my question about nightshades, Paul? What’s your take on whether or not nightshade vegetables contribute to the development or worsening of arthritis in some individuals?

  23. Hi Paul,
    Sorry to ask again but any ideas why a child would develop excessive burping after introducing more potatoes and rice into diet. Previously was eating GAPS like diet but not so strict.
    It’s been a month or two now. The burping is still happening but not as much as last month.

    • Hi Claire,

      When gut bacteria ferment the resistant starch fiber they generate gas. As your child up builds up gut bacteria that are better suited to metabolizing resistant starch, they’ll generate less gas and the burping goes down. Also, when the diet is too low carb, food isn’t moved as well as it should be along the intestine, and this generates blockages that lead to build-ups of gas that come out when the pressure builds up as burps or farts. When they are burps, it means there are blockages/plugs in the intestine and the food is getting fermented above the blockage.

      I would feed the child liver and spinach to promote gut immunity, egg yolks and liver to promote acetylcholine production (for gut motility), and continue with the potatoes and rice to promote diversification of flora and mucus production and immunity. Also, daily exercise, sun exposure, and fermented vegetables.

      Best, Paul

      • Thanks so much for your reply Paul.
        I’ll follow those recommendations. We are doing most of it but maybe not well enough. We do have chicken liver weekly or every other week (luckily my kids have no problem eating liver) so I’ll try be more consistent with that and try to include some lamb or beef liver instead too. From your writings I think you say one liver meal per week is enough. I’ll try spinach too as that’s something we eat rarely. She does have at least 1 yolk a day. Is that enough or should I try to increase this? She already eats sauerkraut almost daily and homemade yoghurt/sour cream or kefir daily too.
        Now that the weather is improving I’m working on increasing exercise and sun exposure too. We really need to work on this.

        It’s funny as my younger child didn’t have any issues with the switch to more starch in the diet despite growing up on GAPS being weaned onto it as a baby. She was the one who always had healthy daily bowel movements where as my older child (the burping one) was always on the slow side, going every other day (part of the reason why we did GAPS). It’s amazing how their digestion and bowel habits are so different despite eating the same foods. My first was born shortly after I had a course of antibiotics towards the end of my pregnancy. Perhaps that had an affect.

        Happy Easter.

        • “My first was born shortly after I had a course of antibiotics towards the end of my pregnancy. Perhaps that had an affect.”


          • 🙂
            But then surely my gut flora was damaged and my second baby would have been affected too, especially since I didn’t eat well those days. But I did start eating fermented foods in my 2nd pregnancy so that would have helped.
            I think I can hear another ‘bingo’! 🙂

            Such a shame that I was prescribed antibiotics when pregnant as it was for a urine infection I never had! But when they realised I was misdiagnosed I had already had 2 days of antibiotics so I was told to just complete the course. I was clueless then about the harmful effects of antibiotics.

        • It sounds like you’re on the right track. I’d expect the older child to keep recovering. I think 2 egg yolks a day would be better.

          • Thanks Paul. We’ll try 2 yolks then. We just can’t keep up with eating all the whites though! That’s 12 yolks per day for our family! Do people throw out the whites?
            Paul, is spinach once a week OK or more? Why spinach? Or would other greens be OK instead? eg spring greens or kale?
            Many thanks!

          • Hi Claire,

            I discard the whites.

            You should have green leafy vegetables daily, spinach is my favorite but that is really just illustrative of the category. I think spinach has a great ratio of nutrients to toxins. E.g. kale is more toxic and lettuce not as nutritious. But variety is good. The more toxic ones like kale or bok choy are best eaten cooked.

            Best, Paul

    • Just wanted to update you. We’ve been following your recommendations more closely (not 100% but trying) and yes the burping has reduced a lot 🙂
      So things are definitely improving. She still complains about tummy pains occasionally though. I wonder if she should be checked for gut infection?

  24. Hi Paul,
    I realize that you are swamped with questions so I hesitate to even ask mine, but as with most others, I am at a loss for which direction to go and don’t seem to have anyone who understands my ‘disease’ . I was diagnosed with primary hyperaldosteronism about 10 years ago. I had a bilateral adrenal vein sampling done and they say that the extra aldosterone is coming from both adrenals. I have been on a medicine that was brand new when I started called eplerenone. It keeps my bp fairly stable but sometimes out of nowhere it will spike again. I have been to the ER with bp at 240/130. The meds make me dizzy and just feel bad. I have 8 children and need to feel good. 😛
    I noticed in your book that you mentioned aldosterone and so it gave me some hope that maybe you might understand my problem. The dr.s just shake their heads and say stay on the meds or the too much aldosterone can scar my heart. Ugh. I have tried GAPs diet for a year but didn’t’ change anything in regards to the aldosterone. I have recently tried VLC for 6 weeks and didn’t loose a single pound. Anyway, I would really appreciate any info you could give in regard to this situation.
    God bless you,

    • Hi Jen,

      This is usually caused by noncancerous tumors/lesions/nodules on the adrenal glands. Usually those are caused by some sort of injury that didn’t heal properly; damaged cells are in a bad state where they are super-active compared to normal cells.

      I don’t know whether it’s possible to fix this but the best chance is to (a) provide support for wound healing and (b) stimulate normal adrenal behaviors by providing the right diet/lifestyle cues.

      So I would get collagen from bones/joints/tendons in stews and soups daily, supplement vitamin C daily to about 1/3 bowel tolerance, optimize vitamins A/D/K2 through sun, liver, spinach, fermented foods, aged cheese, and supplements, support thyroid function with daily low-dose iodine, tend to electrolytes by eating plenty of fruits and vegetables, appropriate salt, and maybe low-dose lithium (5 mg 2x per week), plus magnesium supplements and the bone broth and spinach for calcium. Just as important as food is circadian rhythm entrainment and intermittent fasting – read chapter 42 of our book and give great emphasis to bright daytime lighting, red-yellow lighting at night (and wear blue blocking glasses), daily exercise, meal timing during the day (no night eating), good sleep.

      People who have thyroid nodules leading to hyperthyroidism often fix them in 6-12 months on our diet and lifestyle. So I would think the adrenal nodules should be able to heal, but I don’t know for sure.

      Let me know how it goes.

  25. Hello Dr. Jaminet,

    This is just to comment on the PHD supplementation regime regarding B vitamins. Due to problems with CFS/ME amongst others I’ve had to research these quite a bit recently. Some food for thought maybe for the regime you recommend.

    Your recommendations for riboflavin (B2) are a 100mg supplement. This is overkill. According to most sources it seems that the body will not absorb more than 30mg in a meal (some sources report as low as 10mg): “Absorption takes place predominantly in the proximal small intestine through an active, carrier-mediated, saturable transport process (16) that is reported to be linear up to ≈30 mg riboflavin given in a meal (17). There is little additional absorption of riboflavin in amounts greater than this (18).” (http://ajcn.nutrition.org/content/77/6/1352.full)

    Similarly some sources report that B1 either saturates or loses absorption above 3-5mg, depending on the report (https://en.wikipedia.org/wiki/Thiamine#Absorption). 100mg is surely overkill.

    More importantly these doses may not result in the storage you might expect by taking them only weekly.

    Oral swallowed B12 is also reported to have low absorption (<1%?) and the only way around this appear to be sublingual tablets or injections. Some sources also suggest avoiding cyanocobalamin entirely and only use hydroxycobalamin or methylcobalamin instead.

    Your recommendation to avoid folic acid seems to be spot on with everything I've read and followed it myself, however there are alternatives for people who need it: folinic acid and methylfolate supplements, which I am now doing. I think if you supplement the other B's it is a good idea to add at least a little of these to ensure a balance and prevent a deficiency, and also because a portion of the population has the MTHFR gene mutations and may have trouble absorbing folate from plant sources (http://mthfr.net/). At the moment I take 400-1000mg of methylfolate (metafolin) daily myself in hopes of supporting nitric oxide and methylation cycles; from all vitamins to supplement it appears it may be the single most important for my cause (but of course requires B12 and others).

    I'm not an expert but I figured it was my duty to write this because I've used the PHD as a baseline reference in my exploration, and it's been quite some help. For example the boron suggestion proved invaluable and is often overlooked. I posted here before but forgot under which name(s).

    • Sorry, that’s 400-1000mcg, not mg (!)

    • Hi John,

      Yes, 100 mg doses are overkill, but since the excess is harmless and excreted, there is no problem. Those doses are readily available and inexpensive.

      It takes typically 2 weeks to develop a deficiency, so once a week is sufficient to maintain good status through the week.

      We recommend sublingual B12. In low doses cyanocobalamin is safe.

      My feeling is that a sufficiently high choline intake will eliminate the need for folinic acid or methylfolate, even in people who have the MTHFR gene mutations. But this needs testing.

      Best, Paul

  26. Cathy Fairbrother

    Paul I’m very worried about my best friend. Her health is bad and for years she has had abdominal pain, bouts of hyperthyroid and pancreatitus. The specialists now say that the pancreatic tubes are deformed and one in her pancreas in completely blocked. They removed her gall bladder to get to the pancreas and soon will operate to put stents into the deformed and blocked tubes/ducts. She has been told 20% develop chronic pancreatitus after the if it occurs operation and of these %5 die. The pancreatitus can lead to cancer. She is only in her early 30’s. She read of a woman who cured her pancreatic cancer with the Gersons protocal and although she doesn’t have cancer but because the problem involves her pancreas she plans to follow the Gersons protocol and have surgery. Gersons is devoid of protein and fat from what I can gather and I’m scared it could make her worse. Apart form the PHD book what information can help her. She needs something specific to her own problems. It sounds to me like much of her issues are possibly autoimmune. She was diagnosed celiac some years ago which points to gut dysbiosis and autoimmune issues, but now eats corn and I’ve observed she gets pain after corn. I’m very worried about her doing Gersons and don’t know what to do.

    • Hi Cathy,

      She needs to realize her problems are infectious in origin and PHD is the best approach. Keys to overcoming these small intestinal/pancreatic infections include:

      – Optimize vitamins A, D, K2. Get sunshine on bare skin, supplement to keep serum 25OHD at 40 ng/ml, eat liver once a week and spinach/carrots daily, eat fermented foods, aged cheese, spinach/greens, and supplement vitamin K.
      – Take vitamin C as a powder diluted in water, 1 g C per 8 ounces water. Sip through the day. Take it until it doesn’t taste good.
      – Eat PHD. This is the most supportive of immune function and wound healing.
      – Work on gut flora with fermented foods and appropriate fiber (resistant starch, fruits and vegetables)
      – Entrain circadian rhythms. See chapter 42 of our book.
      – Do intermittent fasting. 16 hour fast daily
      – Get daily exercise, 30 minutes

      For autoimmune issues, she should first of all eliminate grains except white rice and cook rice in a pressure cooker, test nightshades to see if she is sensitive, and work on digestion. Possibly taking digestive enzymes with meals will help. Sarah Ballantyne’s book The Paleo Approach can provide detailed advice if she thinks this is the route to go.

      Fruits and vegetables are good for you so the Gerson therapy has its good points, but it is far from providing everything she needs.

      Best, Paul

  27. Cathy Fairbrother

    Paul I just want to tell you about my son who we have recovered from Aspergers Syndrome as it may be useful info for someone. Apart from testing for Pyrolle disorder and starting the supplements which made a massive difference we took the gut healing route. He could not tolerate any starches. We had to keep him starch free which was a struggle. Then we discovered Dr Houston digestive enzymes and he could tolerate starches with them. The imrovement going starch free was marked but when we added atarches back in according to PHD amounts he came ahead in bounds and had energy for the first time in years. He had been so tired. Now we notice that if he has too many starches he suffers and too few and he suffers. He was allergic to at least 6 foods (really allergic) and after two years following PHD with enzymes for casein and starches he has now been cured of his allergies. I think many more people on the Autistic spectrum could make better progress if they ate starch but used enzymes rather than cut out all starch. We have made this progress without probiotics or ferments even in just a few years he is not on the spectrum any more. Also he had constitutional growth delay and was at the first percentile. Once he was on PHD with enzymes and pyrolle supplements he started to grow more and now sits on the 10th percentile. Thank you for your book.

    • Hi Cathy,

      That is wonderful! Thank you for sharing that. My best wishes to your son!

      Best, Paul

    • Cathy, Paul shared your testimony with me as I just heard about this diet. My 12 yo son is 55 lbs and only 4’5″, in the 3rd – 5th percentile. He has muscle now because of all the protein he eats but NO FAT!

      I have had him on the SCD for 3 months hoping to heal his gut, improve moods, etc but am not quite sure about it. He needs some carbs. He lost weight starting the diet, which concerned me. The SCDers say it is part of the healing. He has no energy and is always tired. We do other biomedical treatment for his Autism symptoms, too. I would love to chat with you about the enzymes you used, etc. Can we email one another?

      • Cathy Fairbrother

        I’d be happy to chat. Is there any way you can get my email address form Paul, or he could give me yours? Have you had your sons Zinc plaasma/Copper serum levels checked? Most of these kids are zinc deficient and that will give them issues with growth often. Also Zinc B6 and magnesium help us process dietry fats and carbohydrates I hear. If he has a compromised digestive system his nutrient absorbtion will be under par….we can chat more. From memory SCD contains nuts and some legumes. My son did poorly on a SCD type diet. He was better without any starches than starches without the enzymes. He still gets tired if we don’t keep his animal protein levels up to the PHD upper limits and his starches low. We have to balance the protein/carb/fat really well. The fact that we have cured his six allergies is proof enough to me that his gut has healed a lot without doing SCD or GAPS. 3 months isn’t a long time. I found we made no progress with energy levels until we identified the foods he was reacting to including some ‘intolerances’ that were not allergic reactions.

        • My son also had autism-spectrum issues, along with anorexia, very slow growth (between zero and the tenth percentile), and by the time we started a gut-healing protocol when he was 6 (he’s now ten), he had chronic diarrhea and couldn’t tolerate starches or sugars of any kind – for years!

          I am intrigued by the enzymes-to-aid digestion idea, because this winter, when we finally introduced resistant starch, we have also been able to introduce PHD-levels of (non-resistant) starch as well. It is not a magic bullet, but the starch is doing good things. And it’s only been a couple months of starch-digesting, so who knows what good things are in store. And…after all these years of gut healing, despite not knowing exactly what we were doing, have obviously restored some enzymatic ability in my boy. I am eager to see if he begins growing taller…

  28. Dear Paul,

    I have a couple of questions about the UK edition of the book.

    1. On page 356, it says that a fast of 24 hours in mice is equivalent to a fast of several days in humans. It then goes on to say that in mice, autophagy peaks within the first 24 hours, with longer fasts allowing pathogens to multiply, which leads to the conclusion on the next page that humans should fast for periods shorter than 24 hours. However, wouldn’t this actually mean that a fast of several days (equivalent to a mouse’s 24 hours) is optimal for humans?

    2. On page 349 it says that low carbohydrate ketogenic diets inhibit immune cells from killing pathogens, especially fungal infections. However, on page 359 it says that ketosis promotes autophagy, which is a pathogen killing mechanism (as described on page 354). Could you explain this, please?

    A couple of other things, are eggs included in the 340g meat and fish per day? On p.81 and p.170, meat, fish and eggs are grouped together, but on p.397 eggs are listed separately.

    This next one isn’t really a question, just a comment. In the Preface, p.xv, a daily serving of 450g starches and 450g sugary plants is recommended. However, it isn’t until we get to Chapter 10, and page 102 in particular,that we see this is a bit of a vague recommendation. For example, 450g white rice with 450g banana would be far too much. Maybe this could be made clearer in the preface.

    There were a few other minor points with regard to British and American English (e.g. “entrée” generally means a starter in the UK, not a main course; cilantro is coriander), but that was about it. Overall, I was very impressed with the book, and have been implementing it for the past couple of months. I feel great!

    Thanks a lot,


  29. Hi Paul, I was wondering if Potato Starch would interfere with Autophagy. I have SIBO, and have read that the good bacteria need something to feed off of. I have been VLC for at least ten years, and it has done nothing but cause harm to my body, I believe it damaged my thyroid first, than a cascade of other diseases followed. I’m so excited to see how your diet will improve my life!! I’ve had your book for a while now, but have been reluctant to adding the starches. I truly believe I’m addicted to being in ketosis! I’m proof that it is not good long term, and people teaching this technique should be careful. It’s not right for everyone. Your diet provides a very balanced approach. I would love to go to one of your PHD camps, if you should open up more in the future! Thanks for all you and your wife do!

    • Hi Sandy,

      No, resistant starch from unmodified potato starch won’t interfere with autophagy. But I would eat it at the end of your overnight fast, before the first meal, so it really wouldn’t matter if it did.

      We will be having more Retreats, next one will be in October. We’d love to see you!

      Best, Paul

  30. Paul, I know how busy you are but could you answer one little question from me, I’m very anxious and pregnant???!!!

    I’ve had bad digestion for 2 years since antibiotic overuse. I’ve had cameras everywhere, scans bowel scans and breath tests. I finally got my consultant to prescribe Rifaximin and found th same day I was pregnant, I’m obviously very happy. He said not to take the treatment but my digestion is really bad, trapped wind in my tummy especially at night. Any advice??

  31. Hi Paul, do you think our body can become dependant on digestive enzymes if we take them as supplements? The following article has me questioning the practice: http://lifespa.com/digestive-enzymes-the-hidden-dangers/
    I would be interested in your opinion. Thanks for your time and your great work. Do you think you will ever make a trip ‘down under’? 🙂

  32. Hi Paul, what are your thoughts on the effectiveness of metronidazole for blastocystis? I developed nummular eczema and constipation after traveling to South America last summer. A recent CDSA detected a few. I’m researching and looks like it’s not all that effective and don’t want to take an antibiotic if it’s not going to help.

  33. Hi Paul,

    I have a friend, a Benedictine monk, who switched to a paleo style diet 6 weeks ago. He has kidney disease, and since he began the diet, he’s lost over 30 lbs, his lab work looks much improved, but his energy is very low. I’ve been talking with him about detoxification during weight loss, but with his weakened kidneys – not yet on dialysis – I’m not sure what to tell him.

    Do you have some advice to help him as he loses weight?



    • Hi Theresa,

      First, don’t restrict calories too much. Starvation will cause many problems. The health of his kidneys is much more important than his weight. Don’t go too low carb or too low protein. Be very well nourished. Eat all our supplemental foods, including liver weekly and 3 egg yolks daily, bones and joints and tendons in soups and stews. Take our recommended supplements.

      Second, tend to circadian rhythm entrainment. Bright light in the day, blue blocking glasses at night, daily exercise (30 minutes), intermittent fasting, all eating in daylight hours, no eating at night, warmer ambient temperatures in day than at night, regular sleep times, avoid TV at night, get social interactions during the day.

      Let me know how he does.

      Best, Paul

      • Thank you, Paul! I’ll pass on what you’ve recommended and let you know how he is.

        Blessings on your day and retreat,


  34. Hi. All this talk of hypothyroid is confusing to me. I am 41. I have a small amount of Hashimoto’s antibody in my blood. Other thyroid tests come back in the “normal range.” But I exhibit almost every symptom of hyperthyroid except for weight loss (figures). I have rapid heart beat, excessive sweating, extreme exercise intolerance, muscle tension, anxiety, somewhat buggy eyes, diarrhea, etc. Docs keep putting me on anti-anxiety meds but all those do is make me feel like a zombie and I’ve also gained about 25 pounds. I carry most of my weight in my stomach, but I have decent muscle mass for a woman, which I like. My face is chubby and looks inflamed. I’ve done all the eating programs. Low carb… everything. I’m slowly creeping up into pre-diabetic range and at my wit’s end. Not being able to exercise only makes everything worse. (I’ve been this way since I was a child.) I can’t participate in hikes or bike rides with others because I always have to turn back gasping for air with sweat running down my face. I had to drop out of sports in school due to exercise intolerance. Any ideas for figuring this out would be very helpful. If it matters, my carbon dioxide in blood tests always comes back in the Low range. And my WBC is usually slightly elevated.

    • I don’t know of anyone who shares my symptoms. I’d love to hear your thoughts, Paul. Or anyone else.

      • Jenny,
        I just saw your questions about your thyroid and various symptoms. All of those symptoms could be HYPOthyroidism. There is something called “air hunger”, which can be caused by low T3 hormone ( the active thyroid hormone. If your hormones are out of balance, your adrenals will try to keep you going, the result being higher cortisol, or in extreme cases of need, adrenline.
        You need to find someone who knows how to read lab results, or educate yourself. The TSH test is not always a good picture of thyroid output.
        Fixing your diet, and the PHD is a good way to go, can help stabilize your system. Whatever you do, dump the grains!

  35. How does intermittent fasting fit in with adrenal fatigue or anxiety symptoms. I wonder if in those cases it can be counter- productive? I’ve read that to support adrenals one should not fast and eat frequently throughout the day and according to Chris Kresser eat a high protein breakfast. Would you agree?

    • Kenneth Holland

      Hi Claire,

      I hope you don’t mind me jumping in. I tested for stage 3 adrenal fatigue. My practitioners have me on 100-150 g of safe starches a day (potatoes, sweet potatoes etc..) and no fasting..and like you said…protein at breakfast. I’m also on pregnenlone, DHEA and adaptogenic herbs, vitamins and digestive enzymes (I had GERD). I also tested and had no sibo and parasites.

      Hope that helps.


  36. Hi Paul, I am a 48 year old female that went to the doctor for hormone testing ( issues with fatigue, weight gain, night sweats & joint pain – especially in the morning). Instead we discovered I have CLL. However, the Oncologist states its very early stage 0-1 and that the fatigue, joint pain and weight gain are unrelated. I was very depleted in vitamin D so I now take 5000 mg which helps a bit with the fatigue but not the overall joint pain( especiallyin the AM). Am I missing something?
    I have a history of being hospitalized for diverticulitis last year ( after 2 back surgeries) began juicing after that, mostly green and cutting out red meat and breads but still feel bad. Any suggestions?

    • David Andrews

      Hi Dayna…48 is kind of young to get CLL, but I am wondering how your doc diagnosed it. I have had a slight elevation of lymphocyte levels for 6-7 years, and my doc just shrugs his shoulders when I bring it up (I am 69/male), Did he/she do a bone marrow biopsy? Just curious, as I am never sure f I actually have the disease!

  37. There is something amazing about 2 products. Do your research…1.GOJI(SINGAPORE TESTIMONIALS). …2. HYSSOP(HYSSOP OFFICANILIS).

  38. Dear Dr. Jaminet, Today at our pharmacy health screening, I had TC of 343, with 240 of that being LDL (they took it twice since it was so high). Trig. were 148. Six months ago my TC was 187. I have been following PHD, have lost 26 pounds and feel really good. I have 50-60 pounds more to lose. I would not say that I need more carbs, as I eat rice or potato every day. I decided about two months ago to quit taking my statin (did not discuss with my doctor, who quite honestly would not be happy). The pharmacy’s response was “GO BACK ON YOUR STATIN ASAP.” They made me feel like I was a bomb about to explode, but I do not want to take the statin. I want to solve this naturally, so I am going to try the iodine/cooper deficiency route. I have had my thyroid checked many times with no abnormality found. Do you think I am on the right track? Thanks.

  39. Dear Dr. Jaminet, Today at our pharmacy health screening, I had TC of 343, with 240 of that being LDL (they took it twice since it was so high). Trig. were 148. Six months ago my TC was 187. I have been following PHD, have lost 26 pounds and feel really good. I have 50-60 pounds more to lose. 😥 I would not say that I need more carbs, as I eat rice or potato every day. I decided about two months ago to quit taking my statin (did not discuss with my doctor, who quite honestly would not be happy). The pharmacy’s response was “GO BACK ON YOUR STATIN ASAP.” They made me feel like I was a bomb about to explode, but I do not want to take the statin. I want to solve this naturally, so I am going to try the iodine/cooper deficiency route. I have had my thyroid checked many times with no abnormality found. Do you think I am on the right track? Thanks.

  40. Dear Paul, I am a 52 year old female. I have suffered from fibromyalgia, but since being on PHD have had much less pain from it. Today at our pharmacy health screening, I had TC of 343, with 240 of that being LDL (they took it twice since it was so high). Trig. were 148. Six months ago my TC was 187. I have been following PHD, have lost 26 pounds and feel really good. I have 50-60 pounds more to lose. I would not say that I need more carbs, as I eat rice or potato every day. I decided about two months ago to quit taking my statin (did not discuss with my doctor, who quite honestly would not be happy). The pharmacy’s response was “GO BACK ON YOUR STATIN ASAP.” They made me feel like I was a bomb about to explode, but I do not want to take the statin. I want to solve this naturally, so I am going to try the iodine/cooper deficiency route. I have had my thyroid checked many times with no abnormality found. Do you think I am on the right track? Thanks.

  41. It seems Paul as your popularity has grown inevitably comes the critic. Evelyn has a 3rd attack article on you up recently.




  42. Hi! I just read your book and find it most interesting! I already do much of what you suggest (except the starch part) but I have a few questions on how to implement a few things. Also a history of some issues that seemed to get better but I have rebounded and stopped progressing. First, I am a cancer survivor (100% naturopathic ally treated of stage III invasive ducal carcinoma). Shortly thereafter I started having tons of symptoms. Bloat, weight gain, fatigue, severe constipation, puffy eyes, excema, brittle nails and a slew of others. I was diagnosed with leaky gut which I worked long and hard through elimination diets and supplementation to heal. Problem is I never lost weight. I’ve tried everything and have even gained more. I’m up about 15 lbs in the last 3 years. I’ve been on paleo diet most of that time with a recent switch to ketogenic to see if that would help. Nothing. I’ve given up starches a long time ago so maybe this is my ticket! My questions are:
    1) I am not obese and the only segment on weight loss seems to target obesity. would my parameters be the same to lose 10-15 lbs? And if I cut back on some added fat as the book suggests, with what to do I replace those calories? What does the breakdown look like?
    2) Your book mentions nothing about non nutritive sweeteners such as stevia, xylitol, erythritol. Are they allowed on this plan?
    Also if anyone can give some advice on best way to lose stubborn weight I would be most grateful. As a side note I exercise regularly and always have been very fit and toned so this weight really bothers me for many reasons. I also have been tracking my calories in and calories out using myfitnesspal and a body media band for months so I knowing am not overeating.

    • Hi Paul, I have one more question. Your book states to stay away from canola, soy and corn which I do anyway yet it recommends certain gluten free breads made with safe starches that also have some or all of the above listed ingredients. Ie: Rudi’s, Udi’s and others all have at least one or more in them of corn, soy or canola. I’m confused.

    • Hi Paul, I have one more question or clarification. Your book says to stay away from soy, canola and corn which I do but it suggests certain gluten free breads that have one or more of those ingredients in them. I’m confused.

  43. Low Thyroid Heartburn | Gerd & Acid Reflux - pingback on May 13, 2014 at 12:15 pm
  44. Shelley Malachowski

    What about snacking? I have searched the website and book for any mention of the word! It is difficult to make it from lunch until dinner…5 or 6 hours apart. If snacking is ok. can you give some ideas? Thanks!

  45. Hello Dr. Jaminet,
    im still fighting wirh my rosacea.What do you think about EM´s(effective microorganisms) Not worth the money?

  46. Hi Paul,

    I’m a nutritionist working with healing diets and have been intrigued with the PHD for over a year now. Have implemented some of the ideas with good results. I have a few questions:

    RE: grains – I’m a believer in “neutralizing” grains so that toxins or anti-nutrients are taken care of. Before reading your book, the 2 grains I was advocating were quinoa, soaked for 24 hrs in water with a little acid (lemon juice or apple cider vinegar) and a few changes of water. The quinoa would sprout and then I would cook it. The other grains would be raw buckwheat, soaked and sprouted and dehydrated. My question is can one eat these two grains prepared this way rather than white rice or sweet potatoes?
    Q #2: I work with Orthodox Jewish people. On the Sabbath they have to eat bread made from one of the following grains: wheat, spelt, oats, rye, barley.
    As little of 25% of the flour has to come from one of these grains and the rest can be from other non-gluten grains. I’ve developed a sourdough gluten free recipe using sprouted oat flour, sprouted buckwheat flour and coconut flour. If the oat flour is minimal (25%)or 50% do you think this type of bread would still be healthful? During the week they can eat other kinds of non-gluten breads such as 100% sprouted buckwheat or !00% coconut flour made w eggs or tapioca flour bread.
    Q#3: Working with those w digestive difficulties, sometimes proteins and starches together in the same meal are problematic. Should they eat less of the carbs?
    Q#4: MS client who has a real sugar problem. Should he be doing the same quantity of safe starches as the regular person?
    Q#4: Been researching infrared saunas. Is it possible proper sauna therapy could replace the roll of antibiotics in treating chronic infections as some Dr.s well experienced in sauna therapy advocate?
    Thanks and keep up the great work!

  47. Hey Paul,

    I read your book about a year ago and have been following your supplement recommendations ever since. There was a distinct improvement in my motor skills, anxiety levels, and clarity of thought. Thanks for all of your hard work.

    My question: Is there a multivitamin you recommend? The amount of pills to sort every week is a little too much some times (especially when it spills over into two pill sorters).

    I’ve searched a bit for a good multi, but everything out there has amounts of B12 and Folate that I am not comfortable with due to the potential increase in prostate cancer risk.

    Chris Kresser recommends Pure Encapsulations Nutrient 950 w/K, which has a whole 1g B12 (methylcobalamin) and 800mg Folate (L-5-MTHF). Sounds insanely high to me. You recommend 500mg B12 weekly (instead of 7000mg) and 0mg supplemented folate.

    Here’s a couple of studies regarding B12, folate and prostate cancer.


    Second thought: I would certainly buy a Perfect Health Diet-designed multivitamin.

    Waiting patiently to re-buy the book for your next edition.

    Have a good one,


  48. Swarnima Jaitly

    Hi sir , I am 16 n I have my widal test positive but my typhoid test says negative I have 42 lyctosomes (2 are extra I suppose ) coz the maximum count can b 40 I have been prescribed medicines yet after 5 days of it I cannot see any improvement actually I have been diagnosed with it yesterday only b4 that i was prescribed some other medicines plz suggest something to cure it thanks 🙂

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