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. Still stuck on the vinegar question. When you say “commercial” vinegar, do you mean pasteurized, since most,but not all, commercial vinegar is pasteurized?

    Would you say to avoid avoid raw vinegar if dealing with fungus?

    Hi Ellen,

    I would stick to vinegar that lacks live fungus, whatever method they use to achieve that – pasteurization, filtering, etc.

  2. About vinegar and dead vs. alive yeast… I’ve read (not on this site) that it’s harmful to consume any yeasts, even dead ones, on an anti-fungal diet. If so, vinegar would be out, yes? But it sounds like you might be saying dead yeasts are ok, as in vinegar. Would love info or opinions, if you’ve got any.

    Hi SGW,

    Live yeast is more dangerous, because of potentially fungemia risks and/or gene exchange helping existing yeasts evolve. However, dead yeasts will still excite inflammation and toxicity responses and so listen to your body. If a food with dead yeasts gives you trouble, then you can either use detox aids (bentonite clay or charcoal) to remove the toxins or avoid the food.

  3. Hi Paul, Thank you so much for the info! This certainly helps a lot! I am going to try to get my friends doctor to prescribe LDN for right now and if that doesn’t help then the progesterone blocker. If one of these works we’ll know a lot more about what’s going on and can finally treat with diet, supplements etc. The info on IBS and menstrual related pain was also very helpful for my condition. I am printing some of those articles out to take to my doctor 🙂 all the best, Claire

    Hi Claire,

    Just a reminder … the primary purpose of LDN is diagnostic, not curative … it will tell if the opioid system is involved, and because it affects the opioid system differently at different times of day (first blocking it then increasing its stimulation by elevating natural endorphins) … she might find it has a palliative effect, I hope that’s the case … she definitely should remove wheat and dairy from her diet in any case.

  4. Hi Paul,

    All the advice about baby food is greatly appreciated by my daughter. Now she has a question about butter – would it be a good fat for the babies or would ghee be better? The baby liver pate recipe contains organic chicken livers, stock and organic ghee. She asks if she could substitute butter or coconut oil and whether you think butter would be as good as other fats in mashed potatoes and sweet potatoes?

    Hi Francesca,

    I would definitely start with ghee / clarified butter. The fat is safe but the dairy proteins can be problematic; milk casein can be allergenic if not fully digested, and it is hard to digest.

    From ghee progress to raw milk, then eventually to pasteurized milk and regular butter.

  5. Hi Paul,

    I was attempting to undertake a tooth remineralization diet. I have read up on the major points emphasized in this protocol, regarding vit A, D, and K2, as well emphasizing salivary flow. I was wondering if you have any dietary tips that would help with these listed bullet points, or some other methods that could help with the remineralization process. Also, I was wondering if it is wise to stay away from ketosis during this process since I remember you saying that low carb (i.e. ketosis) emphasizes dryness (or lack of moisture via mucin inadequacy). Thank you =)

    Hi Michael,

    Ketosis is OK as long as you get adequate starches in the diet and achieve ketosis with coconut oil and maybe leucine. It’s the starch deprivation, not the ketones, that causes loss of saliva.

    Other things that can help tooth mineralization: extracellular matrix ingredients by eating gelatin, bone broth/stock made with plenty of joint tissue, organ meats, sulfur (say from supplemental MSM or epsom salt baths), and vitamin C.

    Best, Paul

  6. So all this time I have been using raw, unfiltered vinegar thinking it was superior! And I guess if you don’t have fungal issues, it is. I have been using only this kind of vinegar for so long that it never occurred to me to question it. Just goes to show the need to question everything!

    It will be interesting to see if switching to filtered/pasteurized makes any difference for me

  7. I have been dealing with Crohn’s disease, severe eczema, acidosis, hypoglycemia and legions on the spinal cord and throat. I have tried a vegetarian high carb diet for many years and my symptoms worsened. I have recently begun a low carb diet. I have begun to have more energy. I’ve been slowly reducing my carbs and am now done to one bowl of quinoa in the morning (I don’t do well with rice). The rest of my diet is meat with mostly vegetables. I am unable to digest any vegetable fats but able to digest animal fat. I’ve been eating greens, root vegetables, and occasionally sweet potatoes. I am wondering if I should completely cut out quinoa from my diet.

    I should also mention I am severely allergic to all dairy, nuts, seeds, and eggs.

    Any help would be appreciated.

    Hi Raham,

    Low carb is good but very low carb is not. You must get at least 200 calories a day from glucose sources like starches, preferably 400 calories. This is just for proper nourishment.

    You must minimize omega-6 fats. So stay away from the vegetable oils; but coconut oil or palm oil should be good. Animal fats are great and dairy fats are the best. Even if you have a dairy allergy, clarified butter or ghee should be OK.

    In digestive ailments rice syrup or dextrose is by far the easiest glucose source to tolerate. This will be better for you than quinoa. I would try those, plus work in safe starches as you tolerate them, plus vegetables and fruits and berries.

    Best, Paul

  8. Sorry to bother again, but I was wondering if you, Paul, or anyone for that matter might quantitatively know the difference between ghee and the high vitamin butter oil from green pastures. A lot of people seem to be saying that it’s more concentrated..etc, but what exactly does that mean…. like how many times more vitamins does it have than ghee?

    Hi Sam,

    I’m afraid I don’t know but I bet Green Pastures could tell you.

    Best, Paul

  9. Hi Paul,
    I know you views on niacin taken as a supplement.
    But what about on the skin, or more precisely on the scalp?

    I have seen a shampoo or it may actually be a pre-shampoo hair treatment, with the following ingredients listed;
    Polysorbate-80, Biotin, Niacin.

    & any thoughts on the other two (Polysorbate-80 & Biotin) on the skin/scalp?

    Hi Darrin,

    It’s unlikely to do any harm to try it. Hopefully it will work.

    Best, Paul

  10. I have not yet purchased the PHD book but heading out the door to do so! However, I can’t wait to ask one question.

    Despite being diagnosed with fibromyalgia and CFS for years, I have never accepted that diagnois since it seems my illness is “intermittent.”

    Finally, after years of research, I convinced my specialist to put me on long-term pulsed doses of antibiotics and I experienced a remarkable recovery. During all my sick years, my blood work always came back normal (frustrating!).

    Recently, I have been following low carb, low fat for two months now as well as going wheat and corn free. My blood work has come back with some strange results. My kidneys and liver are out of whack as well as high uric acid. Any thoughts? Is this just detox from years of wheat abuse? Or do I need to add more fat in my diet? I only eat safe starches as you have already defined them (about 50 gms per day). I have lost 25 pounds so far and test my urine regularly for ketones. Liver enzymes are elevated and kidneys are producing too much creatine and my estimated GFR is low.

    Thank you for your thoughts!

    Hi Nancy,

    I’ve long believed that fibromyalgia is often due to chronic bacterial infections, due to my own experience and others (see http://perfecthealthdiet.com/?p=76). So I’m very glad you found antibiotics!

    It’s not possible to be healthy eating low-carb AND low-fat. That necessarily implies high protein which is toxic, via generation of high ammonia and uric acid. It hits the kidneys and liver hardest.

    I would just reduce protein to 10-15% of calories, increase saturated and monounsaturated fats and add “safe starches” like rice and potatoes back to your diet, and you should be fine. You need carbs and fat!

    Best, Paul

    P.S. — Not many bookstores carry our book, it’s best to order it from online sites.

  11. Happy Thanksgiving, everyone! I’d like to ask your advice about a baffling problem I have experienced for many years.

    After eating certain foods, I experience intense, painful itching over much of my body (feels like being attacked by insects). The itching doesn’t start immediately after I eat these foods, but later, when my core body temperature rises (on account of exercise, showering, etc.). The more frequently I eat the offending foods or the larger the portions, the worse the symptoms get. I can often create an allergic response to a previously non-offending food by eating it frequently or in large amounts. Eliminating and reintroducing foods doesn’t help. Heavy doses of antihistimines reduce the severity of symptoms, but don’t address the underlying problem or enable me to eat the healthy foods I want to eat. Many PHD-compliant foods trigger my symptoms, including eggs (even egg yolks), dairy (even pastured butter or cream), dark chocolate, and cooked tomatoes.

    I follow your diet and supplement recommendations closely, get sufficient amounts of vitamins D & C, and take quercetin for histimine clearance (as Jamie S has suggested). I eat beef gelatin and fermented veggies daily, and bone broth regularly. I also rotate through a variety of probiotics. Apart from this problem, my health is OK. Sleep and digestion could be better, but they aren’t terrible, and have improved on PHD (thanks!). I have seasonal allergies and often get nasal congestion at night.

    Can you think of anything more I can do to overcome the itching besides just avoiding the (many) triggering foods? Thanks for all you do!

  12. Paul:
    I became hypothyroid 5 years ago after Radioactive Iodine to treat Grave’s Disease. About a year ago, began experiencing chronic hypoglycemia-like light-headedness. Was eating typical SAD food high in carbs and am a very active cyclist. Began searching for answers, and while undergoing tests, discovered another issue; Grave’s Eye Disease (which seems to have run its course; required surgery to correct double vision). Take daily Synthroid and keep TSH <1.
    Presently I am about a month into a strict Paleo routine (following Wolf, Sisson), consuming approx. 600 carb calories/day (added rice and sweet potatoes after getting your book a few days ago). Am doing Sisson's Primal Fitness workouts 2-3 x week. Still light-headed, and since initiating the Paleo diet, have experienced moderate bouts of anxiety and depression, and some adolescent type acne (I'm a 53). Chronic GERD has resolved!!
    Two issues: 1) could the light-headedness be a result of a chronic infection? Given the fact that I was chronically light-headed while consuming mega carbs, and the symptom has persisted into a lower-carb routine, does that give you any clues as to its cause? Bacterial? Do you suggest a ketogenic diet for diagnostics? and 2) re: your book, p.244, high-dose iodine to enhance immunity, would you recommend this treatment for someone with my thyroid history?
    Happy Thanksgiving. I'm very grateful for you and your wife, your book, and your blog.

  13. Mr. Itchy, itching after a hot shower is a common symptom of babesia infections. Be on the lookout for other symptoms: night sweats, and anxiety.

  14. Thanks Paul and also Scotlyn, your information about baby food has made such a difference; my daughter (on the other side of Australia to me) has gone from worrying and not knowing what to do, to having foods she can feel confident about giving the babies.

    Before I could relay your information to her about starting with ghee and gradually progressing to butter, she emailed that one baby had loved mashed potato with butter but one had vomited all of it up. So one twin can’t tolerate egg yolk or butter and one is fine with both, but now ghee will be given.

    The best received food so far is rice cooked in bone broth – both loved it. It would have been an almost fat-free meal though, as my daughter takes the fat off the bone broth as recommended in Wise Traditions Cookbook. Should the fat be taken off bone broth? It’s difficult to know how much beef fat to give six month old babies. Would adding some coconut oil to food lacking fat be OK at six months?

    Thanks again for all this terrific advice.

  15. Hi Paul,

    Found your website by chance and have been very grateful. Your book is going to be an early Christmas present to my Mom (and myself). I might have just missed it, but I haven’t seen anything mentioned on your site about juicing, whether you recommend that or not. A basic juice from leafy greens, an apple, and some lemon is usually what I’ll have. Just curious on your opinion.

    Also, I’ve read from another another nutrition source that possible spikes in blood sugar can be due to ingesting fat and carbohydrate at the same time. Reason being the fat you ingested surrounds the cell, making the sugar from the carbs unable to be taken into the cell, and ends up in your blood stream. (I could be way off base here, don’t have a lot of education in nutrition)

    Can’t wait for the book though,

    Thanks for everything

  16. Hi Paul,

    I’ve been looking into getting the micronutrients you suggest and have been able to find pretty much all without any unwanted ingredients.

    I can’t find a K2 supplement that isn’t made from soy. Is it better to take supplements with a small amount of nasties or should I just try and supplement through diet?


  17. Hi Paul,

    I just stumbled upon your website in my travels attempting to research holistic ways to deal with Grave’s Disease. I was diagnosed at the end of August 2011 and am currently on methimazole to keep the hyperthyroid symptoms at bay. I have an enlarged thyroid (although not physically visible) with a bruit and at time of diagnosis, the symptoms were rather acute, so I do not have a mild or even moderate case. However, it is not a severe case, either. I am 47 yo, female and never experienced hyperthyroidism before. In reading your website, it seems that diet and the mix and types of carbs/fats/proteins/nutrients can have a direct impact on thyroid functioning. I am wondering whether you have any theories from a diet perspective on what might cause or contribute to Grave’s Disease, what imbalances the condition indicates and how that might be countered through diet. I will definitely purchase your book. Thank you.

  18. Hi Paul,

    My sister just got diagnosed with endometreosis as well as getting laparoscopic surgery to remove the improperly placed cells. The doctor is suggesting hormone therapy as a follow up that prevents her from getting a period for up to 6 months. I’m hoping to find some information and suggest a less severe method but the information i’m coming across is confusing. The supposed hormone therapy is supposed to reduce estrogen levels but I’m not really sure how that is supposed to help (i.e. i thought estrogen was in a negative feedback loop in this whole cycle, so if it gets downregulated then more will be produced). Also if there is supposed to be no period for several months doesn’t that mean the endometrial cells will remain highly vascular and thickened like they would when a pregnancy takes place (i.e. how will this help the pain). I was trying to find some nutritional therapies but have only come across modulation of the o3/o6 ratio in an attempt to attenuate the pain through proper prostaglandin production. Any help in this matter would be greatly appreciated. thanks again!

  19. Hi Paul,

    Just a quick update here to correct a previous post and let you know how things are going.

    1) my stepdad’s parkinsons diet:
    I made a mistake about 200g carbs it’s 200kCal which he finds difficult to obtain. So yes he is doing the ketogenic diet.
    breakfast: greek yogurt + crushed “good” nuts (e.g. macademia)
    lunch: maybe some leftovers from diner and or coconut oil
    dinner: generally fish or beef with vegetables and fats
    once a week: 20 hr fast (starts after dinner, breaks dinner the next day) with coconut oil.
    supplements: multivit/min, vitamin C, selenium, NAC, creatine and melatonin.

    2) my friends hormonal problems:
    She read your tips and talked to her gynecologist but has chosen to get a hysterectomy as another episode would be too much to bear. I wish I had contacted you a year or 2 earlier when she was still trying dietary and herbal interventions. She’s the one who got me started on paleo… I do hope someone else benefits from the information you posted!

    3) my own update (gastroparesis + IBS/hormones?)
    You advised to try a ketogenic diet to see if the stomach problems got better. The answer is YES. BUT I had to limit protein – hard to digest which led to stomach upset. AND the yeast/fungal problems exploded despite daily beriberi (from chinese doctor).

    Other things I’ve noticed:
    * yeast/fungal problems also great with high carb diet or when progesterone is high in cycle.
    * irrespective of diet I have 1-3 bad days around ovulation.
    * urticaria is constantly visible but only itchy with high histamines
    * rice syrup makes me queasy – fermented?yeasty?histamines?
    * goats yogurt goes ok! (surprise b/c of lactose intolerance diagnosed by biopsy) -> fasting on yogurt goes ok. (I can get raw goats milk but not sure if that will go ok).

    So i plan on trying low-moderate carb (200-600kCal daily) and adding a multimineral, trying B vitamins and a detox aid. Plus kolorex (found a place that sells it here :)).

    take care!

  20. * oh last point: my teeth are getting see through so that’s why upping the minerals.

  21. hey paul
    i have a question about carbs. Now I tend to follow the PHD guidelines overall but not day to day. By that I mean, some days of the week I eat few to zero carbs, and other days I have lots of carbs (100-150g). Overall though, my intake probably averages around 75-100g carbs per day.
    So what I’m asking is, is there a big difference between eating 75g carb every day, or a more sporadic cARb intake (i.e very little one day, lots the next). Is there a benefit of one approach over the other? Or does it not really matter?


    Hi remo,

    There’s a benefit to matching carb intake to level of activity – on days of intense activity eat more carbs, on days of rest eat less. But don’t go below 200 carb calories on any day, unless you are intentionally fasting.

  22. Hey Paul,

    First off, long time reader of the site and the book. The diet has worked wonders for me and I’ve passed it on to friends and family that are experiencing similar results.

    I’ve almost eliminated my adult onset acne completely but I still have some problems. After eating certain foods, I break out almost immediately (2-3 hours). Sometimes these result in a couple of deep welts on my face that are painful and sometimes induce significant swelling. Do you have any idea why this occurs? I’ve narrowed it down to some specific foods based on being very, very restrictive and creating a baseline of normalcy. Currently it’s limited to red meat and just now a specific type of smoked sardine that I find around here. Do you have any idea why certain foods would do this? I would love to get back to eating some grass fed beef sometime in the future.

    Also, I’d be interested to hear your views on male pattern baldness and if you know of any way to prevent it.


    Hi Nick,

    I’m glad you’re doing well!

    Your specific food sensitivities are not that common, but not unknown. Red meat can sometimes cause trouble due to Neu5Gc sugar residues that can carry bacterial toxins into the body, or that can trigger antibody formation themselves. A variety of toxins can be created during smoking of salmon.

    I’m not sure what to advise. It’s possible if you eat a bit of red meat regularly you’ll develop a tolerance to it. Or it might be best to avoid them. Perhaps Googling will give you some information. Or you might want to visit an immunologist/allergist, get tested for food allergies, and ask his advice.

    In the meantime, working on improving your gut ecology by eating fermented vegetables is probably a good idea.

    Best, Paul

  23. I just started supplementing vitamin D3 because my level was 24. Surfing the web tonight I came across the Marshall Protocol, which, at first, I took to be in line with your ideas, or at least the idea that infections are the root of much disease. But, the protocol strongly advocates against any vit D supplementation and says that levels should be <20. The argument is that D suppresses immunity and allows infection to thrive. Are you familiar with this idea? Obviously you don't agree with it. What are your thoughts on the idea that D suppressed immunity, even at low levels? Thank you.

    Hi SGW,

    Yes, I’m familiar with the Marshall Protocol. I believe the science is quite mistaken. They’re right I think that chronic infections cause most disease, and that pathogens sabotage vitamin D pathways to disable immune responses. However, they’re quite wrong to think that natural vitamin D is an inferior activator of the vitamin D receptor compared to drugs like benicar. This is based on Marshall’s computer modeling of the vitamin D receptor which no one but him believes. It is most unlikely that evolution would have failed to come up with a good design for vitamin D – vitamin D receptor coupling. As a practical matter, his strategy of lowering D has exacerbated the disease of a host of chronic disease patients who tried his protocol.

    Best, Paul

  24. Hi Paul, I’ve had a query in my clinic about an alternative enteral (direct tube feeding) formula for a relative that cannot swallow subsequent to throat cancer treatment. This is what he is getting the majority of his nutrition from. The ingredients list looks like the leavings from the factory making pellets for nutritional studies of mice – it’s frightening. Corn, milk casein, and soy seem to be the main ingredients. Have you ever checked whether there are any enteral feeding formulas that more closely resemble the PHD? It might be useful to add a link to your supplements page if you can find one.

    Hi Scotlyn,

    Here is a long list of enteral feeding formulas available in the US: http://www.drugs.com/cons/enteral-nutrition-formulas.html.

    I haven’t scouted the formulas to see if any look healthy. But if the goal is only to bypass the throat, why not give him milk? It’s not easy to beat milk as a nutritious liquid food.

    Best, Paul

  25. Just as a follow up this link is a review of the evidence for different enteral formulas – apparently very little, as the FDA does not require “food supplements” to be as rigourously studied as medicines. The article does, however, provide a “homemade” enteral formula recipe, largely made up of baby food, which would appear to be a huge improvement in the quality of ingredients. I thought the use of coconut milk in the place of the vegetable oils and sugar syrups might bring it well in line with a PHD-friendly nutrition plan. Very strict attention to hygiene would be necessary, of course. Your thoughts?

    Blenderized food would be better than those formulas, but I still think whole milk might be both easy and hard to beat for healthfulness.

  26. Hi,
    I hadn’t seen your reply in my last post, but I wonder how much of a volume of milk a grown man would need to get 1800 kcal a day? This man cannot manage more than a couple of swallows of water a day even, so no matter how liquid, he would still have to take this largely by tube.

    I will print them off a copy of the study I linked to, with its “homemade” recipe suggestions, anyway.

    Hi Scotlyn,

    Whole milk has about 160 calories per cup, so 11 cups a day would be 1800 calories. Yes, I was assuming he would have to obtain it by tube. Even if they blenderize food, they could mix it with whole milk.

  27. Hi Paul,

    I came across your site recently while searching for updates on some the recent diet trends (especially with pop books like Taubs and Ferriss). I really appreciate how well researched your posts are, as well as the abundant citations.

    Another topic which has been very popular is body pH, which seems popular in vegan circles. This is the theory that most peoples pH is too low, and low pH is caused mainly by animal proteins and processed grains.

    I was searching on your site for any info on this, and wasn’t able to find any. Have you posted on this topic, or could you share your opinion?


  28. Hi Spencer,

    That’s been speculated about for a long time, but there’s still little evidence it’s important.

    The body regulates pH pretty closely, so the main impact of dietary acid-alkaline producers is on the pH of the urine. This is relevant for kidney stones, urinary tract infections, and such, but not for most of the body.

    Some speculated that excretion of minerals as buffers to control pH might lead to mineral deficiencies, but this seems not to be the case.

    There may be some relevance to gut ecology, but this is complex.

    So I monitor the topic but haven’t found anything compelling enough to warrant a post.

    Best, Paul

  29. Wow, thank you for such a quick reply. It is certainly hard to keep up with all of the research, what studies have been robust, and which are weak links.

    Last quick question before I go off to buy the book. Do I gather that the problem with legumes is toxicity?


  30. Hi Paul,

    Thanks so much for the reply above. Just as an FYI, I can generally tolerate fiber rich foods (i.e. lettuce, cabbage), but not high histamine/histamine releasing ones (i.e.potatoes), altho sometimes I can. But in general I try to avoid them, as well as the high fructose foods.

    Ok, so got the Metametrix results. From what I understand, I tested positive for strongyloides (threadworm) and some other unknown parasite. Also, “Yeast/fungi, taxonomy unknown” was high, +4, and an opportunistic bacteria, Morganella morganii was found. The only other thing that is abnormal is that fecal cholesterol is high, 209. Nothing in the pathogenic bacteria was found. What do you think? Any advice? I will be talking to my doctor next week and not sure how he will want to proceed, but any advice from you would be greatly appreciated. Thanks again.


    Hi Naomi,

    Well, your doctor may have better ideas than I do how to proceed from here. My guess would be to treat the threadworm/parasites first, and maybe an antibiotic treatment for the Morganella (see http://en.wikipedia.org/wiki/Morganella_morganii), but I would eat lots of fermented vegetables and yogurt to try to replenish healthy bacteria. Fungi generally need slow treatment and so I would attack those last. You might find that a long course of fermented foods will reduce the fungal population.

    But I think since you have multiple pathogens there are a lot of choices, and all may be good. I would pick one to attack, treat that, eat fermented vegetables, and then maybe re-test after 2-3 months to see how your flora is doing.

    Best, Paul

  31. Hi Paul,

    I just finished your very informative book and enjoyed it throughly.

    I wanted to ask your opinion of AHCC (Active Hexose Correlated Compound) supplements for cancer prevention. They are extremely popular in Japan, the research is very convincing but the pills are pricey at recommended doses. What do you think about these? I’m a hypochondriac but otherwise young, healthy, extremely physically active and have been following all of the advice you dispense long before I even knew who you were.

    One more question: your book doesn’t make much mention of cheese. In terms of disease prevention, how would cheese consumption fit in with your diet? I understand it’s not exactly Paleo but I limit it to mostly varieties from raw milk/grass-fed cows or goat/sheep’s milk rather than cow’s milk.


    Hi Lou,

    Mushrooms and mushroom compounds do seem to have a good track record against cancer in studies. My general perspective is to eat the foods until there is solid data in clinical research. I haven’t examined the literature for AHCC supplements so I don’t know where the evidence stands on the supplement. But there is well supported evidence for shiitake, maitake, reishi, and a few other mushrooms. I think unless you actually have cancer I would just eat the mushrooms; if you do have cancer then I would investigate further.

    I think cheese is fine unless you have a dairy sensitivity. We eat cheese. Dairy is among the “Pleasure Foods” in our Apple/Food Plate and that means it’s good in moderation.

    Best, Paul

  32. Hi Paul,

    I was just reading an old post from cheeseslave at http://www.cheeseslave.com/how-intermittent-fasting-caused-my-insomnia-and-belly-fat/

    and was wondering…I attempt to intermittent fast and eat a high fat/adequate carb diet (i.e.400 carb calories) and I have yet to feel good from it. I was wondering if maybe this is a sign that intermittent fasting is not right for me. How do you diagnose whether high fat/intermittent fasting is right for you or counterproductive?

    Hi Michael,

    Well, it’s a good question. Intermittent fasting is not right for everybody. The most common problem is difficulty with blood glucose or circadian hormonal regulation, causing hypoglycemia on a long fast. You can check for that with a blood glucose meter.

    Infections can make fasting intolerable or difficult.

    You can also try adjusting the fast with a bit of food. Two things that ease the stress of the fast are (a) protein or (b) MCT oil / coconut oil. “Protein-sparing modified fasts” that restrict calories but provide some protein allow people to fast much longer. And MCT oil or coconut oil promotes ketone production and facilitates adaptation to a low-glucose fasting state, without reducing the benefits of the fast.

    But I don’t think we yet know all the possible reasons that fasting can be difficult. The link between insomnia and fasting is obscure to me. So do some tests, but ultimately you have to listen to your body and work out what’s best for you.

    Best, Paul

  33. Hi Paul,

    Can you explain why some people, me included, don’t feel well on a low carb diet? I find that even 20% of my calories from carb is too low. I have significant mental health issues and low carb seems to exacerbate them, but getting around 40% of my calories from carbs relieve them. Thanks

    Hi Nick,

    Carbohydrate needs can vary, especially if you exercise, but if you need a lot then I start to wonder about bacterial brain infections. I had one and it led me to drink large amounts of soda, since raising blood glucose would relieve a cognitive hypoglycemia.

    If that is it, then taking large amounts of MCT oil or coconut oil should also work — that will generate ketones as an alternative fuel for the brain.

    So I would try a ketogenic diet for a bit and see if that works also. If so, then I would look at trying antibiotics to see if they relieve any of your cognitive/mental health symptoms.

    Best, Paul

  34. hi paul, thanks for your reply to my earlier question. I was wondering if you could expand a bit further on why it’s best to have 50g every day, and more if exercising.
    My understanding is we need x amount of glucose a day, and if we haven’t just eaten glucose our body draws from glycogen stores. Hence why i can eat all my carbs in one sitting instead of spreading it throughout the day. And so, if i need 50g dietary carb a day, if i eat 100g on one day and zero the next it wouldn’t matter much since my body would just draw from glycogen, in the same way I can eat 50g of carbs at breakfast and none the rest of the day instead of around 15g carb at every meal.
    I hope this makes sense. Am i correct or am i mistaken?

    Thanks again for helping me understand this!

    Hi Remo,

    Glycogen stores are not very large, liver glycogen can be depleted in 36 hours or less. So if you don’t eat carbs at all on a day then your glycogen may be depleted toward the end, and your body will be stressed. 50g per day carbs relieves that stress.

    I am fine with intermittency (alternating high/low) in glucose intake, but intermittency should be on top of the 50g minimum.

    Best, Paul

  35. Regarding my earlier questions mistakenly on the recipe thread: I had thought that I read an actual sentence rather than putting it together from a chart, and I thought it was seven years. But again, I was bouncing between books — TPHD and GAPS — so am back to GAPS and reading from the beginning. Perhaps I’ll find it again, and will let you know if I do.

    Another question of greater immediate importance, as it has to with significant pain: I have successully managed osteoarthritis for nearly 20 years by eliminating certain foods from my diet, one being safflower oil. Nearly a year ago, after unintentionally ingesting safflower oil in my vit D caps (company reformulated and I didn’t read label), I began having severe pain in my thumb joints. The pain was so, pronounced that I could not ride my bike. I ride a road bike every summer for about 1000 miles total. When I discovered that I had been taking safflower oil everyday for a month I stopped and the pain got much better. Soon after I discovered that chicken was a new food that gave me pain, so I stopped eating chicken. The pain had been gone for some months when I went to W.T. in Dallas. Returned home with a conviction to “heal and seal” my leaky gut and, perhaps, restart producing sufficient HCl. I had been diagnosed years ago, but was not given hope I could fix these issues. I am 2 weeks into daily beef broth, with as much of the fat as I can stand, and the pain in my thumbs has returned, and is quite bad. Could it be the beef fat? The broth itself? I’m certain I don’t have any other significant source of omega 6. The broth is all that has changed in my diet. Normally it is safflower oil or chicken that will cause this kind of pain. I have so many food intolerances and was hoping that GAPS would help put me right, but if I can’t eat the broth, what hope is there? My system is highly sensitive, and I wonder if the leaky gut is at the core. I even got hives on my neck and the insides of my eyelids from a new deodorant (natural, etc). Thanks for anything you can offer. For now, I’m giving up the broth. Fish broth sounds less than great, but that may be what I have to go with.

  36. Dale,

    Did you try the beef broth with the fat taken off? And if you do okay with that, then try it with adding butter or ghee or coconut oil or even very carefully (as per the PHD recipe) rendered beef fat ?

    I think the fat may be damaged from the long cooking of the broth. If you refrigerate the broth for a day the fat will form a solid layer on the top and is then easy to remove. (I Leave it on as a “seal” to protect the broth till I am ready to eat it. It will keep for quite a while that way)

  37. Dale,

    Ellen made great suggestions. One other idea is to make briefly cooked meat broth instead of bone broth for now. Dr. McBride suggests this in her book, for sensitive folks. Directions are in the book.

    For some reason I react not so postively to broth myself but it seems to have really helped my health overall, so I recommend that you keep pursuing it.

  38. I surely have to believe that the people on these threads are among the very kindest people in the world. No surprise that a person such as Paul J. would so easily gather such folks about him. Like does attract like.

    Thank you so much for your prompt replies and interest. Yes, I am a grandma and have logged many years in the kitchen and know about getting the fat out of broth :), so have been refrigerating it and removing the fat. Initially, I had the bone broth without the fat until I read in Natasha’s book that I was to include the fat. Well, there is a lot of fat, so I have been warming a couple cups of the broth and dropping into this a good-sized chunk of the solidified fat. I should have kept a “broth diary,” as I don’t recall the day I began to include the fat nor the day I first noticed the pain. My plan is to freeze what I have in the fridge, and then freeze the pot in process. Then I’ll stop the broth altogether with hopes of soon returning to my pain-free life. Then, I’ll go back to the fat-free broth. I like the idea of adding coconut fat or ghee to the broth, and will try that. I can be quite ADD when reading books like PHD, and have not happened on the “rendered fat” section. (Could so use an index for this book.) In Dallas, I had no pain the days I drank the beef broth, but on the third day braved the chicken and, indeed, had thumb pain.

    This morning lay in bed reading step 4 and wondering how to test for those pathogens. Then, if that would explain the health issues I have had this year (sinus, colds, sore throats), how to access the “new” antibiotics alluded to in PHD. Also, wondering how I will manage to consume the recommended amount of coconut oil. I have a (gulp) 5-gallon bucket arriving next week from MN, so I’ll have the stuff on hand, but can’t fathom how I will get 12 tablespoons per day into my belly. I’m a very busy school counselor and remembering to drink my water all day is a huge challenge.

    Thank you again for picking up the baton in the “nicest people in the world relay.” I so appreciate such kind folks as you.

  39. Hi Paul,

    So I recently got diagnosed with SIBO and am starting a short course of Xifaxan. I’m curious if probiotics would be beneficial, detrimental, or neutral during or even after the antibiotics. Also, would you recommend any variations to the basic PHD?

    Thank you in advance for your input!

    Hi Brian,

    Yes, probiotics are beneficial, but fermented vegetables and dairy even more (quantities of bacteria are higher). They are beneficial both during and after. The basic PHD is still good.

    Best, Paul

  40. Thanks Paul for the response. Unfortunately, I cannot tolerate ferments right now with the histamine problems, but maybe later after getting rid of the parasite and the Morganella.

    I read that Morganella causes histamine production in fish and is responsible for scombroid poisoning (http://en.wikipedia.org/wiki/Scombroid_food_poisoning) , which is what it seems like I get every time I have a histamine episode (except that I do not fish). I looked on pubmed and didn’t see anything linking Morganella with histamine production in humans, just things like sepsis, UTI’s…

    Also, Paul I seem to recall mention in comments from last June that you were going to do an anti-fungal series of posts. That didn’t happen yet, right? Is that still going to happen?

    Hi Naomi,

    Good find, it makes it seem like maybe the Morganella is something to go after early … or maybe it causes the histamine when combined with the parasites, or some such thing.

    Yes, I will do an anti-fungal series. I’m still experimenting with my case, that’s why it’s been delayed.

    Best, Paul

  41. Dale, here is the link to the recipe for rendering beef tallow. It is not in the book. It can be found in the Categories under Food, then Fats and Oils


    And even if you are doing a ketogenic diet you will most likely not need anywhere near 12 T of coconut oil. Somewhere around 6, but go according to how you feel.

    But if you are not doing ketogenic, need two T of CO

    And…be sure you have no fungal issues before you try the ketogenic diet.

  42. Hi Paul,

    My question is in regards to intolerance to low carb (or adequate carb). I know it was mentioned above that bacterial infection seems a likely culprit if you need more carbs than your body “should” be using. It would be great if this was the case, but after reading much of this blog it seems you have a predisposition to accusing bacterial infection. I am by no means judging this, but just find that there may be other factors at play (i personally would be happy if it was a surefire sign of bacterial infection so i could know exactly how to proceed). The additional aspect to my question is besides ketogenic dieting (which i personally cannot do–too hard for me after trying many times and failing miserably), can other diets/foods be used to add diagnostic criteria? I know that sugary drinks will increase my blood sugar for a very short period, so it’s very difficult to see if my mental acuity is improved over a very short period of time; personally i am addicted to high calorie junk foods, they produce a significant increase in blood sugar for extended periods of time–the wonders of fat and mass carbs in conjunction. I know many people are beginning to blindly follow this idea that everyone has an individual diet preference, while i personally adhere to the belief that individuality in diet is governed by individual pathology; though we all have genetic differences i don’t think they are large enough to govern major differences in food consumption (i.e. kitavans don’t eat potatoes because they have some proclivity towards them, rather it’s because that’s all that is available)

    Hi Jason,

    I always keep bacterial infections in mind as a possible explanation, but that doesn’t mean that I think they are a likely explanation in any given case. One has to consider all the symptoms and all the possibilities.

    But I’m a little short of explanations for low-carb intolerance that don’t involve pathogens. A possibility is nutritional deficiencies in vitamins required to process amino acids; especially biotin. So try taking 5 mg biotin daily for a while plus a B-50 complex and a multimineral supplement and see if that helps.

    I agree with you that individuality in diet is due to pathology; healthy people all have nearly the same optimum diet, and good tolerance for a wide range of diets.

  43. Thank you, Ellen. I do suspect that I am so overloaded with omega-6, that even the better omega-6 to 3 ratio of beef may be a problem for me. Thus, I don’t understand how rendering the beef fat would make it less a problem (if it is a problem – still working on that). Can you explain that for me? I am not purposely going to a ketogenic diet. In Dallas I was so encouraged at Natasha’s promise that I could “heal and seal” my gut that I hoping to end up on the GAPS diet. Right now I’m lining up my ducks (or cows, as it were) so that I have some of the food prep requirements, equipment, and knowledge. This has been a culture shift for my kitchen experience. Whereas before I simply did a hot water rinse to clean my vitamix, now it takes plenty of hot water and dish detergent. I have jars of beef fat sitting around because I don’t know what to do with this substance that was demonized from my childhood.

    Thank you for commenting on the 12 T of CO. Now that you mention it, in my ADD reading style, and jumping to the back of an informative book before earning the right to be there, I did read that in the “losing weight” section. All I ever knew before PHD about ketones was from my days as a 4-H mom. We were told to watch our lambs for ketosis, which was a bad thing. For now, I add about 3 T to my morning fruit smoothie. My weight of 130 on my 5’6″ frame is not a concern at this time.

    Has Paul commented on healing and sealing a leaky gut on the PHD? Also, I have gotten into the habit of taking a significant number of supplements. Severe osteoporosis and AMD in my maternal family history, along with a few random maladies. I began working late in life and need to continue to work for sometime to come. Sidestepping these torments is a major focus for me. Thus, I am very hesitant to give up my calcium citrate/magnesium, lutein, strontium, NAC, glucosamine sulf, and those that PHD recommends, along with several other supplements. Perhaps Paul has had similar questions asked of him.

    If Paul gets to my missives I fully expect this kind and gentle man to admonish me to read the whole book and then start with my questions. I am a desperately slow reader with a desperately demanding job and reading for me happens in short snippets of time.

    Thank you, again, Ellen, and anyone else so inclined to help me out.

  44. Dale,

    Well it may be the omega 6 overload or it may be the damaged (long cooked ) fat that is causing your problem. Or it may be something else. You will have to experiment to find out.

    The rendering is simply a way to have fat that is less damaged. It won’t change the ratios.

  45. It hadn’t occurred to me that preparing the bone broth as directed in the GAPS book would also damage the beef fat. I have been slow cooking it for 72 hours. Maybe this is an example of why NC-M directs one to read the entire book before beginning the diet. I will stop the broth and the fat for now and begin the broth again when the pain is gone.

    I’m not clear on why further heating through rendering would make the fat more user friendly.

    Thank you so much for your help, Ellen.

  46. Dale,

    Well, the beef fat IS more stable than the chicken. It is relative. But it still contains some fragile fats, as Paul explains in his post on how her renders beef fat:

    “The reason for pulling out the oil is that beef fat contains a variety of components which have different melting points. In general, triglycerides containing short-chain and polyunsaturated fats have lower melting points, triglycerides containing long saturated fats high melting temperatures. Fats with lower melting points tend to be more chemically fragile. You don’t want to overheat the fragile oils, damaging them; but you need to be able to apply more heat to render the high melting temperature fats. The solution is to separate the oil from the fat several times, and gradually turn up the cooking temperature each time.”

    What do you mean by “further” heating? I was talking about simply rendering raw fat, then adding it to the cooked broth from which the originalfat, that had been long cooked and thus possibly damaged, was removed and discarded.

  47. Hi Paul,

    Thanks for all that you do. I’ve struggled all my life with overweight, binge-like eating disorder symptoms, and fluctuating weight and (undiagnosed but quite obvious) volatile blood sugar. I’ve been roughly following PHD for some months now and it has seriously reduced all of my previous binge-eating, hunger craving symptoms, as well as vastly increasing the amount of time I can go between meals without feeling frantic or emotional. I haven’t lost much weight, but my weight has stabilized whereas before I was on a steady gaining trend.

    My question is more general as maybe others will be interested in it. I recently realized that I very probably have AD/HD without the H (more typical for women) and was reading about it and discovered that ADHD brains are slow to process glucose.

    I mostly wonder if you’ve ever looked into this and discuss the implications for ADHD/ADD people trying to follow a PHD diet.

    For my own personal anecdote, I find that I simply can’t not eat fructose without my brain feeling hungry. That’s the only way I can describe it. If I go for a day, or sometimes even a morning with only eating the safe starches (including rice syrup, which I put in my coffee) and no fruit I simply MUST eat an apple or strawberries. This is regardless of if my stomach feels hungry or not. I was just curious if you think this is a real thing or something I am making up.

    Also wanted to put it on the comments to see if anyone else reading the PHD site has ADD/ADHD and is trying to treat it with nutrition has any insight into this.

    Thank you so much for all that you do.

    Hi Elizabeth,

    I would never think you were making something up. There’s no arguing with direct experience.

    It sounds like the normal liver pathways for storing glycogen are not working properly, but with fructose around to the liver does OK. I’m not sure what the issue could be, I’ll have to think about that. I haven’t heard of this before. Fructose can help speed up glycogen generation, also fructose handling depletes ATP levels and that might promote glucose metabolism. So there are multiple pathways by which it could have an effect.

    I’ve read that ADD/ADHD are influenced by opiate pathways and thus that gluten or dairy or chocolate, which can activate opiate pathways, may influence it, and low dose naltrexone may relieve it.

    I’ll put your experiences into my notes and look into the literature when I have time to see if anything looks like it might explain this.

    Best, Paul

  48. Hi Paul,

    First of all, I love the Perfect Health Diet. Thanks for all the work you have done.

    My question for is about, of all things, my tongue. I noticed that it has turned yellow! Do you have any idea why this has happened? Some sort of bacteria overgrowth, perhaps?

    I’m going to try gurgling salt water 3x/day, as well as doing a short coconut oil fast (maybe 48 hours) to try to starve the bugs out.

    Do you have any ideas?

    Thanks so much

    Hi Nick,

    Not sure what to make of yellow tongue. Oral thrush from fungal infections is usually white.

    The Mayo clinic (http://www.mayoclinic.com/health/yellow-tongue/MY01069) says it might be an early sign of a disorder called black hairy tongue (http://www.mayoclinic.com/health/black-hairy-tongue/DS01134) which is a bacterial overgrowth.

    I would say good oral hygiene, saline washes as you’re doing, and see if it goes away.

  49. First, thank you both for this wonderful service. My problem is that I have been following Food Combining for so long although it is the most frustrating way to eat. I read your book and really want to dive in all the way, but I have this one belief that has me imprisoned. I know you don’t prescribe to Food Combining—Protein foods with only non-starchy vegetables, carbs not to be mixed with protein at the same meal. Fruits should be eaten alone and so forth.
    The proponents of this philosophy explains that carbohydrates require an alkaline medium to break down their starches, while proteins need an acid. Acids and bases (alkalis) neutralize each other. If you eat a starch with a protein, digestion is impaired or completely arrested.
    I know I am very brainwashed, having believed this concept for so long, but I truly wish to break this belief. Wondering if you can do a little refuting about the fallacy of Food Combining. Would you scientifically explain why this is a farce. I have such respect for your knowledge. I know it is solid science. I am sure that such an explanation from you will finally free me.

    Hi Isabel,

    I do think Food Combining is fallacious and one shouldn’t separate meats and starches when one eats. Mixing them slows down digestion which is beneficial; it lowers glycemic index of the starches, for instance.

    According to this site, http://www.learn-from-my-self-improvement-journey.com/food-combining.html, the logic is that starches and proteins are digested at different pH, and so can’t be simultaneously digested in the same place; but that’s fine, because they are meant to be digested in different places. The stomach is always acidic and the intestine always alkaline, so you always have a place to digest both.

    The site claims that starches are alkaline and reduce the acidity of the stomach. I know of no evidence for this. I haven’t tested the pH of starch-water mixtures, but this site claims a potato-water mixture is acidic: http://answers.yahoo.com/question/index?qid=20060924192237AAHLvn7. Regardless, the starch is not going to alter the pH of the stomach much. The idea that most starches are “alkalinizing” in the body is true, but this is only after they are metabolized, not before digestion. They are not alkalinizing in the stomach.

    Similarly, proteins may trigger more stomach acid production, but this is not going to prevent starches from being digested.

    I hope this helps!

  50. i lent my copy of the book to a friend and now i am trying to piece together how to do a phd-style ketogenic diet or “fast” both shorter and longer term. i think the basics are:
    up to 12 TBS/day of coconut oil or mct oil, choose mct oil if…? not clear on whether i should do only mct oil, only coconut oil or a mix of both.

    supplement amino acids lysine, leucine and BCAAs, but to what amount per day i do not know

    supplement glucose up to 400 cals a day?

    i’m trying to figure out the maximum amount of protein and carbs to eat and still stay in ketosis, and then what kinds of protein (great lakes gelatin plus lysine plus BCAAS?)and carbs (in my case only brown rice syrup)

    a phd ketogenic flow chart or infographic would be awesome

    Hi Darius,

    200 carb calories a day, 400 protein calories, 4 tbsp MCT oil or 6 tbsp coconut oil, intermittent fasting, up to 5 g leucine either alone or as BCAA mix is a good addition to help maintain muscle.

    Best, Paul

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