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!
    Been on the PHD for some months now, feeling great. Eczema almost gone. But there is one problem, the diet has given me very loose stools. I cant really connect it to a certain food. Maybe it’s the higher amout of fat that my stomach isn’t used to? Or what do you think? Maybe som supplements to recommend?

  2. Your book says to avoid Canola Oil yet it recommends Udi’s Bread, which has Canola Oil listed as one of the ingredients. Can you explain?
    thank you

    • Hi Pat,

      Well, I don’t really endorse Udi’s, or any bread, but if you must eat pre-prepared bread, then theirs was the best brand readily available at the time we were writing.

  3. What is the difference between Raw Honey and Honey. Are either beneficial for consumption (following the Perfect Health Diet) for someone trying to get their HDL’s up and Triglyceride down?

  4. Hi Paul,

    I know you mentioned a while back that you intended to do a post on GERD, I am wondering if that happened and I just can’t find it?

    I have been riding this roller coaster for quite some time (and have been PHD for years). I can be symptom free for months and then all of a sudden, I have daily heartburn. I would like to squash this thing once and for all. Any thoughts you might have would be great.


    • I listened to a talk on this once. Apparently toxicity can lower stomach acid and cause acid reflux/heartburn.
      Do you have amalgam fillings? They have mercury which can exacerbate GERD type problems I believe. If you do, consider having them removed by a holistic dentist who follows a safe procedure and detox protocol.

      Also, there could be a chance you have a pathogen in stomach?

      I’m sure Paul will have better ideas

    • Hi Lindsay,

      I still intend to do it but haven’t had time to prepare a long post. But one tip, are you eating our recommended egg yolks and liver? Both are important for GERD.

      • Hi Paul, Speaking of writing new posts, I would be very interested in a post specifically on divertuculosis/itis/um…if you have time for that.
        Many thanks

  5. high paul, hope you may have time to read this 6 page review of the 2012 banting memorial lecture.
    dr taylor has re-established normal blood glucose in type 2 diabetics, by reversing the process that started it, [liver and panceatic fat”. he claims B-cell are not perminently damaged and can be reawakened. can this diet be safely used even for a short time to any benafit. are there other ways to safely decrease liver and pancreatic fat.
    thks alfred

    • Hi Alfred,

      That’s a rather stringent fast to undertake, and obviously not a sustainable diet. I prefer going a little slower with a sustainable diet using intermittent fasting, nourishment, exercise, and other tactics to get rid of excess energy and achieve the same outcomes.

      Best, Paul

      • thks paul, we will be continuing with the phd. in 6 months my prediabetes A1C of 6.6 has come down to 6.1 will share next reading in 6 more months.
        i’m not to sure by how much we can benafit my wife’s insulin type 2 situation however we are keeping her A1C at 6.6- 6.8 while holding to the same or less insulin per day. thks alfred.
        P.S. both of us fasting 16 hrs every day, NEVER feel hunger.

  6. Hi Paul,

    First off, this isn’t so much a question, I don’t really know what to ask, my situation is complicated, but if you’ve got the time to have a look, I would be most grateful.

    I’ve had severe OCD/anxiety since the age of 13. It came on suddenly and hasn’t let up for the past 9 years. Anyways, I discovered this healthy wholefoods scene (whether that be PHD, paleo or primal) about 18 months ago. What convinced me that this way of eating is the answer to my issues was the argument that being pre-diabetic can cause adrenaline release, promoting anxiety.

    Thing is, I haven’t been able to stick to any sort of healthy diet for more than 3 days. I think the OCD must have damaged my dopamine reward system so much that I literally have 0 motivation. I’ve had to take a year out from University, and I’m living in my family household. Whilst my family are sympathetic, there’s no hope of me convincing them to get unhealthy foods out of the house, so my sugar addiction always defeats me.

    I recently read your article on the effects of typtophan on mice and it felt like I’ve just discovered another piece of the puzzle regarding my OCD. Given that coming off sugar is just too hard for me at the moment, do you reckon a lower protein diet might be helpful to reduce tryptophan levels?

    If you’ve got any other thoughts on how I can help myself, I’d love to hear them as well.

    • Hope you don’t mind me to step in, before Paul finds the time to reply.

      I would suggest for you to research the topic of methylation and how it relates to OCD.
      From my experience, OCD is often the result of undermethylation. There are natural protocols to correct it.
      Good luck.

      • Thanks so much for responding to my question Dora. I definitely agree that the methylation cycle plays a role in OCD. I think I’ve been avoiding researching it because it’s such a complex subject, but you’ve prompted me to look into it again. At the very least I think a low dose methyl b complex could help (until I sort out my diet), and I should probably look into my homocysteine levels.
        Thanks again.

        • Roman,

          My bipolar daughter found great relief of both depression and anxiety from Deplin methylfolate. It’s expensive and isn’t covered by insurance, but has allowed her to progress to the point where she just successfully completed her first year of college.

          • Hi Sarah,

            You might try choline and phosphatidylcholine instead, they’re much cheaper, with some vitamin B6. Circadian rhythm entrainment is also critical for bipolar. Lithium helps too.

            Best, Paul

  7. I’m switching to the PHD from about 3yrs as a vegan followed by 4 months on the Grain Brain. What I’d like to know is the healthiest way to ‘gain’ weight on this diet. As a vegan I ate as much as I wanted and maintained a weight of 147 almost to the pound, ( I’m 5’9″ and am 66 yrs old ). I lost 4 lbs after switching to the Grain Brain and was okay with that, but now I’m down to 136 and would like to gain some back. I get plenty of exercise and in otherwise good health ( high cholesterol, but good heart disease risk ratio ). Haven’t seen any comments about the best way to go about putting weight on. Thanks

    • Hi Steve,

      A balanced diet with an emphasis on saturated fat (butter, coconut milk), protein, and starch will help. Good nutrition. Circadian rhythm entrainment. Intermittent fasting and briefer more intense exercise (heavier weights, running/sprinting vs jogging/walking, intervals).

  8. Hi Paul,

    You mention in some of your answers that one should eat enough glucose to avoid hypoglycemia. I was always under the impression that I had reactive hypoglycemia, because it often happened a couple hours after a high-carb meal (and sometimes even not that high). Today I had nothing but coffee and coconut milk for breakfast (despite waking up hungry). For lunch I had a large stir-fry with chicken, veggies, plenty of coconut oil, and some sweet potato (roughly 100 calories worth of the sweet potato). I felt really good afterward. An hour later, I tested my blood sugar. It was 93, which surprised me since I had the sweet potato. 2 hours post-prandial it was 80, and by that time I was moderately hungry. 3 hours post-prandial it was still 80, and I was completely starving. I had to eat an apple and loads of cashew butter to feel normal again. It felt similar to a hypo attack (without the sweating and clamminess of true hypo). I’m really confused as to what this means.

    Do you think I should have had more starch for lunch? That wouldn’t leave me much for the other meals though. Granted, a glucose reading of 80 doesn’t constitute hypoglycemia, but the readings do seem somewhat low overall. I haven’t done a lot of glucose monitoring, but they are always either low or normal (lacking the extreme highs of reactive hypoglycemia). Any advice on the starch intake?

    For reference, I am healthy weight (though recently gained 10 lbs for some reason), female, 45, with some energy and mood issues, some cortisol dysregulation and hypothyroid (currently on T3 only to cycle out RT3).

    Thanks for listening, and thank you SO much for your fantastic book and blog!

  9. Hi Paul. Love the PHD and follow the guidelines although I discovered I was not eating enough starches so upped the white rice and potatoes. It may be coincidental but my gut doesn’t seem to be handling them very well now and I’ve developed slightly sore joints in my hands (they’re ok once warmed up). I have been tested for leaky gut (positive) and for years have not been able to handle any supplements (symptoms of Hashi’s and Adrenal fatigue get worse and worse the longer I stay on them). Even high doses of Mag citrate do not induce loose stools, although I can take vit c and mag oxide to relieve constipation. I am considering Organic Acids testing to see what’s going on in the ‘loop’ but in the meantime, how can I incorporate starches without reacting? Dextrose? And what about the availability of GMO free dextrose? I am in Australia so products may be different to USA. Thanks for your time Paul. Your site is very much appreciated; full of valuable information! 🙂

  10. Hi Paul
    I guess I’m behind the 8 ball – I just learned about the problems with carageenan from listening to your podcast with Evan Brand. I’ve had gut problems in the past, so I guess I’ll be returning a few boxes of Trader Joe coconut milk.
    But I’m confused about how the problems with carageenan relate to consumption of seaweed in general..I thought seaweeds were a healthy snack, and that the polysaccharide parts of their constitution, just as in okra, were good for the digestive tract. Is that true, and it’s only some other part of a particular red seaweed that’s problematic, or are all seaweed polysaccharides suspect for the same reason carageenan is. Or do they all contain carageenan?
    What do you recommend about consumption of seaweed?
    Thanks for any info.

  11. As someone who is allergic/sensitive to eggs (per an iGg test), would you recommend a choline supplement (if one even exists)?

    Thank you

  12. Hey Paul and Shou-Ching,

    I was just looking into the benefits of bone marrow and did some research on alkylglycerols, which seem to have interesting effects on white blood cells and immune function generally. A search of your site didn’t bring up any info on it so I was wondering if you had researched them and had any insights into their benefits. Here’s a study I found, which looks like it’s also a meta-analysis of other studies:


    I noticed that I felt unusually satiated after eating roasted marrow. More so than with other fats that I can usually tolerate high quantities of and still want to eat more.

    Also, as a fan of your book, I’ve given away a couple copies now and need to get a new one. Is there a new edition on the way anytime soon or should I go ahead and get the one that’s out now?

  13. I am reading the kindle edition of PHD and can’t find the appendix on adapting the diet for vegetarians that Paul mentioned somewhere on the site. Was it included in the kindle version?

    • Hi susy,

      That was in the 2010 edition of our book. In the 2013 Kindle version, that appendix was reduced to a single paragraph in one of the later chapters. Basically, your nutrient needs are the same, and it is a challenge to get some of them which are found only in animal foods; therefore it’s important not to be a vegan, and to eat eggs (fish eggs, bird/poultry eggs), dairy, and seaweed and such. … I will spell it out further at some point.

      Best, Paul

  14. I’m not sure this posted, so my apologies if it shows up twice.
    I am reading the kindle version of PHD and am looking for the appendix that Paul mentioned somewhere on this site, covering a vegetarian adaptation of the diet. Does anyone know whether that is included in the kindle book? I can’t seem to find it.

  15. Hi Paul,
    Thank you for your important body of such thorough research. I discovered you through Chris Kresser, bought the book and am now a follower.

    I am struggling with Hashimoto’s and have uncovered blastocystis hominis and yersinia infections. In addition, I took an IgG food sensitivity test which showed allergy to dairy, gluten, and both egg yolks and whites.

    My question is whether an IgG test is truly accurate and whether I should really trust these results. Is there a better food sensitivity test out there? What about an IgA test?

    I searched your site and did not find a clear answer for this and would love to see you do a post on food sensitivity testing, its accuracy, pitfalls, and usefulness in healing.

    Thank you!

    • Hi Erin,

      Not being a clinician I don’t have personal experience with these tests so I can’t speak to their accuracy. But, I would still eat egg yolks only, because the nutrition is hard to replace, but discard the whites and mix the yolks with food and warm it / cook it, which makes it much better digested. Gluten is good to avoid at all times. Dairy, that is less important, you could remove it, or just eat fermented dairy, such as cheese or yogurt, and clarified butter / ghee.

      • Hi Erin,
        I also recently had an IgG test that showed a sensitivity/allergy to eggs, both yolks and whites. Whites I can give up, but have been debating whether or not to add yolks back in because of their nutritional benefit. I would love to hear what you decide, or whether you find any information regarding test accuracy. Giving up eggs, especially yolks is a hard decision.

  16. David Andrews

    Paul, I have read elsewhere that hard-cooked egg yolks have “oxidized” cholesterol, which would imply that soft-cooked ( or raw?) yolks would be preferable. Do you have an opinion on this?

  17. Hi Paul,

    I follow the PHD (still working up to eating enough liver). I posted here previously when I only had high blood pressure if I wasn’t lying down. I now have it all the time and have done 24 hour ambulatory BP testing and it was very high. Got up to 140/116 or something like that. I am 24.

    I’m on the pill and my doctor thinks this is the reason for my BP issues and wants me to go off it which I am doing- though I’m titrating off to try to avoid the acne from the sudden change. I have since read some of Ray Peats stuff and to be honest it is a bit rambling and contradictory but it still kind of stuck that he thinks hypothyroid can cause hypertension and that the current acceptable TSH range is too high (mine was 2.6 which Ray Peat says is not optimal and is potentially hypothyroidism). My cortisol is very high and Ray Peat said this can mask true TSH levels. I am very cold intolerant and have difficulties with memory and attention. I am underweight (according to BMI- I look fine though) but he said that doesn’t rule it out. My sleep is good.

    Just wanted to know what you think re hypothyroidism being likely under such circumstances and whether it can really cause hypertension.

    • Hi Sophie,

      It’s true that hypothyroidism can cause vascular problems including high blood pressure and that a TSH of 2.6 often indicates a so-called “subclinical” hypothyroidism which would benefit from treatment. Google the symptoms of hypothyroidism and see if they look familiar – cold intolerance is one. Even if you don’t have many, I would ask the doctor to prescribe you a low dose of levothyroxine and see if you feel better on it.

      For blood pressure vitamin A (liver, also green leafy and orange-yellow fruits and vegetables), vitamin D (sunshine), nitrates (green leafy vegetables, beets), vitamin K2 (aged cheese, fermented foods, supplements), vitamin C, bone and joint stock, magnesium, iodine (low dose daily, seafood) are likely to help, as is circadian rhythm entrainment (chapter 42 of our book), intermittent fasting, daily exercise.

      Be careful not to undereat, especially when doing intermittent fasting. Fit much larger meals than you are used to into a narrower daytime feeding window.

      Yes, I do think you are somewhat hypothyroid and that that is a factor in hypertension.

      • On the topic of blood pressure, I tend to have low blood pressure. The last measurments I had were sitting: 89/57 and standing up 67/47.
        I’m only 30 and have always had low blood pressure like this. Doctors say it’s fine since it’s only high they worry about but I’m not convinced. Any ideas about causes of low blood pressure? I can’t find much online.
        Thanks so much.

        • Hi claire,

          The first possibility that leaps to mind is insufficient electrolyte intake and dehydration. Try eating more salt, fruits and vegetables, bone and joint stock, and mineral water.

          Next, the adrenal-thyroid-hormonal axis. Start with circadian rhythm entrainment.

          Third, eat plenty of precursors for neurotransmitters involved in vascular relaxation, such as choline (egg yolks, liver), and precursors for nitric oxide like nitrates (spinach and beets).

          I would also peruse lab tests carefully for other numbers such as red blood cell counts or clotting times for things that might indicate subtle medical issues.

          Best, Paul

          • Thank you.
            I think I could try drinking more in general but I do already have broth daily and occasionally coconut water too. I salt all my food with himalayan or greay salt and have increased my salt intake over the last few years since thinking low salt was good in my younger years.
            I am getting my adrenals checked. Yes I can work on circadian rhythms. I am really struggeling with going to sleep early and tend to have late nights. But I do sleep enough and have black out blinds so it is quite dark when I do sleep.
            I already do eat liver weekly and yolks daily. I aim for 3. I have recently increased my intake of leafy greens. I have always had beetroot in my diet if that’s what you mean by beets.
            That’s interesting about the tests you mention. I’ll try speak to someone about getting those done.
            I’m wondering if I’m prone to heart failure as 3 people in the generation above me have died from it.

          • Hi Claire, I would say the sitting numbers are close to normal but the standing numbers are way too low. Do you get dizzy? What happens if you measure blood pressure in the legs instead of arms? What happens if you lie down? What happens to your pulse? Does it race when you stand?

            I think the doctors really should be the ones to investigate. There might be some nervous system issues involved.

          • Thanks for your tips. I’ll try the blood pressure in all the different ways you mentioned. Doctors have never thought much of it. They just say low is better than high. They only ever test me when I’m sitting though.

        • Hi Paul,

          Thanks for your response. I’ll discuss the levothyroxine with him. If I feel better on it is that likely diagnostic? Also, is levothyroxine one of those things that makes your own body stop producing it if you take it? Also, is iit likely to have an effect on acne either way?

          Other than ensuring sufficient daily calorie intake (I probably am not- some days I just have no appetite for proper food- yesterday I had green tea for breakfast, had soaked buckwheat porridge with butter and coconut oil for lunch and for dinner “ice cream” which is about about 3 yolks frozen with double cream with a little yoghurt on the side. Today I’m craving red meat so will probably eat lots.) and upping carbs even more, are there any other dietary/supplemental things to help with hypothyroidism?

        • I used to have normal blood pressure, then I got into the whole lower carb/candida paranoia thing. I lost 60 lbs over about a year and a half. Now I can wake up at night with a blood pressure of like 85/65, unless I have enough salt with dinner and some salt and water mixed. So I think low blood pressure has something to do with stress, low weight and slower metabolism. My doctor says the same thing about it. He’s just happy it’s not too high.

      • One last question: levothyroxine vs dessicated thyroid?

  18. Hi,

    Congrats to your book, it has been very interesting reading it and it gives great insight in how everything depends on what we eat.
    I have been suffering lymphedema and lipedema for 15 years now and I was wondering whether PHD could improve my swollen feet and/or whether there is anything special I should take into account when applying PHD.



  19. Hi, Paul. You’ve helped me tremendously with issues I’ve had with my thyroid, adrenals, formerly VLC woe and the issues that resulted, gut health, the whole lot – but I have a question for you in regard to antivirals and what effect they can have on gut flora. It feels like somewhat of a silly question, but I’d honestly never really thought about it. I’m having to take Valtrex to combat a recurring reactivation/flare-up of Herpes Zoster – which, in my body, likes to manifest itself as Bell’s Palsy (3x over the last 20 yrs – it even switched sides the third time) and now what seems to be BPPV or something greatly affecting my inner ear and causing vertigo and other debilitating, annoying issues. Is the Valtrex going to wipe out the progress I’ve recently made with my gut health and repopulation of my gut flora? I’m still taking an SBO and always at least one other probiotic, doing the PS, fermented foods, etc, but am I going to be fighting an uphill battle while on the med? I’d like to know which bugs might be wiped out and what I should do to try to maintain what I’ve got going on in there now, so I’m willing to take or do whatever I need to. If it’s really going to cause damage, I’ll look into other ways of knocking this virus back down. I already follow all of your rec’s, and then some.

    I’m also wondering what in my body seems to be setting the stage for the times when the virus does pop back onto the scene – as in, does a more acidic environment make it more likely, etc….It almost always follows the ingestion of strawberries and home grown tomatoes, oddly enough. Then again, I wonder if it’s the crazy heat of summer that’s present when I am inhaling those things.

    Thank you in advance for any help you are able to give.

  20. alfred hennessy

    hi paul,i thought you mentioned on a recent metabolism summit it could be usfull to take one teaspoon/day of creatine to build muscel.
    i am exercising for an upcomming hip replacement operation. would that be helpfull for me and should i increase any PHD supplements ahead of and after the procedure. thks alfred

  21. Hi Paul / Shao-Ching !
    I’ve been paleo for 2 1/2 years and PHD for one, and I still have acne as well as mild digestive issues. As someone who is nineteen and took antibiotics for months as a teenager, (who also occasionaly wears a retainer) I show strong signs of fungal infection, dandruff, trouble dealing with ketosis etc.

    I am currently supplementing with your recommended daily nutrients in addition to everything necessary to support my thyroid (using 1 drop of Lugols / day for Iodine)
    Additionally I take prescript assist and primal flora, as well as Thorne Labs Methyl-guard

    I avoid some Fodmaps.

    I consume 8 tbs plantain flour for RS each day and consume 2 tbs great lakes beef gelatin per day
    Any suggestions? After all this time I feel I must be doing something dramatically wrong!

    P.s. Using oil of oregano on and off, looking into garlic as well. Natural antifungal should be comparable to things like fluconazole, no?

  22. Hi Paul

    I have the PHD UK edition – excellent.

    My husband has cardiovascular disease and his kidneys are failing. I am desperate to help him with diet. He is on meds for high blood pressure including diuretics. Can the PHD diet help him? Which things in particular should he focus on for the blood pressure /kidney failure?

    I have read about the ketogenic diet (87% fat, 8% protein,5% carb) reversing kidney disease in mice, but can’t see human trials. I am a bit confused now and this is so serious you can’t play around.

    Thank you

  23. Menopause

    Hi, I am entering menopause and I am wondering if you can shed some light on how I can use nutrition and your diet to help with some of the symptoms I am experiencing. I have read that menopause symptoms seem to be according to some research a very ‘western developed world’ phenomena

    I have a history of mild anxiety and went through IVF late in life to have my child (now 4 yrs). It seems like virtually overnight I started having symptoms of insomnia, not really night sweats but getting very warm over night, and most annoyingly to me, weight gain around my middle. I also find I can feel quite low at times and have recurring headaches. My serum hormone levels for progerone and oestrogen were all clearly at the menopausal level.

    I am not sure how to eat anymore. I eat relatively well – low wheat gluten, high protein and low carb, but despite how much I ‘manage’ eating, I am continuing to gradually gain weight around my middle. I tried intermittent fasting before where I would have an 18 hr fast until lunch, and I feel that this triggered my insomnia and made me feel quite hyper and agitated by end of day. I am otherwise a very fit woman!

    Can you suggest how I can stop the weight gain, avoid feeling low and sleep better through diet?

    Thank you in advance for your help.

    • Jennifer,
      I am similar to you and looking forward to Paul’s answer to you. I am fit, and I eat fairly PHD, and I intermittent-fast; but have been gaining belly fat steadily for 2 years.

      In the past if I were eating practically no sugar and no grains, I’d shrink to a size 2. Now I keep having to buy bigger pants.

      One thing that has helped my perimenopausal insomnia and moods has been a product called Femennessence, which is basically a concentrated maca root capsule. My MD recommended it, and I haven’t slept this well since my first pregnancy in 1993! I get it at Whole Foods/Whole Body. They sell it online, too, but I get a better price locally for some reason.

      I also haven’t had a headache since taking the maca root, but could attribute the headache improvement to some other things I’ve changed. Not sure.


  24. I recently purchased your book, as well as Russ Crandall’s “The Ancestral Table,” and am excited to get started, including intermittent fasting (which terrified me before, I’ll be honest). In addition to improving my health and reducing migraines, my primary motivation is weight loss. I really related to your chapter on weight loss, including the link between lack of nutrients and the failure of overly-restrictive diets. This resonated with me for many reasons. Here is my question: In the weight loss “version” of PHD, you suggest maintaining PHD levels of protein and carbs, but limiting fat. In Russ’s book, he suggests cutting carbs and eating more fat. I assume your suggestion is the correct one, as his book is based on your principle, but perhaps you could clarify? I find that there is a great deal of contradictory information regarding fat (I stick to healthy fats only, butter, coconut oil, etc), and just want to understand this better.

  25. Keith Skilling

    My nephrologist told me I can eat 1 gram of protein for each kg that I weigh. This works out to 183 grams (6.45oz). I reduced the number somewhat to factor in losing weight. Not factoring in oils, this would mean I could eat 475.7 grams (17oz) of produce a day. I think I am messing something up here. I am trying to figure out how to plug my number into a dietary journal to figure out calories. Help?

    • Your calculation of 183 gm protein is correct if you weigh about 400 lb.
      •Hamburger patty, 4 oz – 28 grams protein
      •Steak, 6 oz – 42 grams
      •Most cuts of beef – 7 grams of protein per ounce

      •Chicken breast, 3.5 oz – 30 grams protein
      •Chicken thigh – 10 grams (for average size)
      •Drumstick – 11 grams
      •Wing – 6 grams
      •Chicken meat, cooked, 4 oz – 35 grams

      •Most fish fillets or steaks are about 22 grams of protein for 3 ½ oz (100 grams) of cooked fish, or 6 grams per ounce
      •Tuna, 6 oz can – 40 grams of protein

      •Pork chop, average – 22 grams protein
      •Pork loin or tenderloin, 4 oz – 29 grams
      •Ham, 3 oz serving – 19 grams
      •Ground pork, 1 oz raw – 5 grams; 3 oz cooked – 22 grams
      •Bacon, 1 slice – 3 grams
      •Canadian-style bacon (back bacon), slice – 5 – 6 grams

      Eggs and Dairy
      •Egg, large – 6 grams protein
      •Milk, 1 cup – 8 grams
      •Cottage cheese, ½ cup – 15 grams
      •Yogurt, 1 cup – usually 8-12 grams, check label
      •Soft cheeses (Mozzarella, Brie, Camembert) – 6 grams per oz
      •Medium cheeses (Cheddar, Swiss) – 7 or 8 grams per oz
      •Hard cheeses (Parmesan) – 10 grams per oz

  26. HI Paul,
    Just wondering what you thought of C-reactive protein. My CRP was just over 20. I thought I had a digestive issue but a stool test showed no inflammation in that area, and all markers are within range. I’m looking into possible inflammation in the reproductive organs. Is 20 high? I’m working through your book and making changes as I go along but I wonder if there is another test I should do?

    • Claire,

      That is very high. c reactive protein should be under 1 for low risk. Under 3 for average risk.

      A friend tested at 25. He had no idea why… But .After a few months on PHD it was down to 7, it is probably even lower by now.

      Get with the PHD and I bet you will see that number come down. Be very vigilant about no grains, only safe starches and no vegetable oils. Test for CRP again in six months on the PHD program. I wouldn’t bother with other tests till you have done that.

      • Oh dear. Doctors didn’t seem to be concerned at all.
        I have already been doing WAPF for a few years then some GAPS and now PHD for a few months. I haven’t had refined Veg oils for years. So diet wise I’m doing OK I think. I need to work more on the supplements but I am taking Vit C and a few others but will probably adjust. I need to work on my will power to get to bed early though. I’m also going to get tested for gluten (Cyrex labs). I am grain free apart from starches but I do have wheat in communion at Mass every day. So I need to check if I have a genuin sensitivity to gluten as even that small amount is too much if sensitive. I’m wondering if I have pelvic inflamatory disease (despite scans and swabs for it showing nothing) due to pain in ovary area. The pain actually came on a few months ago just after I started PHD diet- adding in more of safe starches
        I really don’t know what’s going on and doctors are not very helpful e.g. they recommended I try the pill or have an operation to have a look! No thanks.

        So what are the risks of having crp 20+? I am slim and look healthy-ish, I found it could be a viral infection at that level? If I find I’m not gluten sensitive I’m not sure what else to look for.

        • *safe starches

        • Hi claire, High CRP is usually a gut infection and pain upon adding starches is consistent with that, Klebsiella and other infections can do that. Make sure you get lots of liver, spinach, carrots, beets, sunshine, and circadian rhythm entrainment (see chapter 42). Best, Paul

          • Thanks Paul. I will most certanly keep trying with the recommendations. I already have been doing weekly liver, almost daily carrots (could this be too much- juicing), regular beets for the past year. In the last month or so I have increased leafy greens especially spinach. Sunshine and circadian rhythm I really need to work on! Bad habits die hard.

            I hope you don’t mind me giving a brief history regarding the tummy pain. This issue hasn’t given me much peace since it started.

            1 year ago I had occasional lower left or right mild pain. It felt like a stone in my ovary area. would come and go for a week or so.

            Next episode: under 1 year ago.
            One day I developed bad indigestion/acid reflux- something like that, after having a snack with water. That evening I became nauseous, weak and had a fever. It felt like food poisning. By next day I was almost better. After a couple of days I developed the worst diarrhoea ever. Liquid orange and difficult to contain. It passed after a few days but after that cleared I developed the lower left tummy pain. It was more painful when walking or crouching. But wore off after about 3 weeks. At this point I was eating semi GAPS- having occasional sourdough bread and potatoes. Maybe a small amount every day but not with every meal.

            I completely forgot about the pain.
            I had a death in the family and started eating wheat bread(stress) and a few months later the pain came back but more mild. But I had started PHD starches a few weeks before the pain onset-rice was the new frequent addition. It felt like a stone or bubble that was annoying. Approx Feb. On the third day I decided to try a garlic oil poultice on it over night. The next day I woke up with pain that radiated all over the area and round the back. I also developed a fever that day. A visit to the doctor led me to 2 nights in hospital of tests. They gave me one dose IV multi strain antibiotics but later decided this was not the correct course of action as I did not have elevated white blood cells. My CRP was initially 25 with the fever. After 2 days and fever gone my CRP was about 21. All investigations found nothing wrong- chest x-ray, ultrasound scans of pelvis, vaginal swabs. When the area was palpated by doctors it did not hurt more to the touch. Apparently my groin lymph nodes were slightly raised though.

            A few months later, and the pain is much improved, no longer constant and not every day. When it does come on it tends to coincide with a bowel movement. The pain is still in the similar lower left area but sometimes can be more towards the middle and sometimes the sensation is more of a burning feeling, sometimes pinching/tightness.

            I did have a private stool test done recently. This one http://www.gdx.net/uk/product/64
            but my results were suprisingly good. Everything was within range. No pathogens found. Eosinophil Protein X was 1.8 and Calprotectin was <16

            That's why I thought it must be a reproductive problem ? PID or endometriosis that can affect the gut?

            The funny thing is this. I had my first menstrual cycle recently (due to being pregnant or breastfeeding the last few years). When it started my bowel movements changed- they seemed to have impproved- more regular and frequent. On the first day I had some painful gases though (something I haven't experienced for years). That's why I wondered if there is a hormonal component.

            Sorry I have tried to be as brief as possible. From what I have said do you still think it could be a gut infection? I am really confused about this issue.
            Thank you for your input.

          • So sorry. That looks like a long post!

          • I just found out I’m pregnant. This i very nexpected but the baby is very welcome of course.
            I have been put on some supplements from my holistic dentist where I recently had my amalgams removed and wonder if the supplements are suitable. I’m still working my way though your book. Is what you suggest still suitable for pregnancy?
            Daily I have been taking based on my dentists recommendations:
            Magnesium ascorbate 3g
            Ascorbic acid 2g
            Potassium citrate 2g
            Selenium 100mg
            Methathione 125mg
            Glutathione 25mg
            Magnesium 150mg
            Zinc 12 mg

            Q10 50mg

            I’ve stopped taking the beatcarotene, flaxseed oil, evening primrose oil, Vit B complex and Vit E based on what I’ve learnt from PHD.

            I’ve also started taking 400units of Vit D3 and some seagreens seaweed capsules.

            Shoud I change anything else supplement wise? I’m looking for a choline supplement but I do try to eat 3+ yolks daily now. SHould I take Vit K supplemet during pregnancy?

          • I have just had my CRP checked again and I am happy that the level has gone down to 12. SO that is good news that it seems to be on the way down but it is still high. Since I am pregnant I wonder if there is anything else I can do to help lower it quicker, e.g. turmeric supplements?

            In the same blood test my TSH was over 4, which was worrying. I know it used to be around 1 a few years ago (when I ate similar to SAD) so I can only assume that it is related to my CRP level being up. Inflammation and stress both can affect the thyroid. Perhaps it was higher when my CRP was 20.
            I’m working on PHD as best as I can. Is there aything else I can do to improve my TSH back to my previous levels?
            I am anxious to speed up the healing process because I am pregnant.

          • Hi Claire,

            You should really get your doctor to give you some T4 thyroid hormone. Hypothyroidism takes time to cure and it is not good for the baby.

            Best, Paul

          • Oh dear, really? Is taking T4 thyroid hormone safe for the baby? I guess you are saying it is. The problem is, my doctor thought my levels were fine. I only realised they are not from reading your book!

            Just looking at my blood results again: my serum T4 level was 13.14 pmol/L and my serum free triiodothyronine level was 4.2 pmol/L.
            I don’t understand what these mean at all but my doctor said they were fine. Do you still think it’s worth me asking the doctor for thyroid hormone? Which is the safest one out there or most natural?

          • Hi again Paul, Just been reading your post on thyroid: normal is unhealthy. Very worrying information. You mentioned T4 thyroid hormone, but what about the natural thyroid hormone supplements e.g. Thytrophin PMG by Standard Process which contains bovine thyroid (processed to remove its thyroxine).
            Also, erhaps I should start upping my dose of iodine. Currently I have been taking about 390µg iodine in the form of 2 seaweed capsules. Do you think I should start increasing this?

          • Update: I had a misscarriage (my first, previously all healthy births). I spoke to the doctor that it may be my high TSH 4.15 and CRP 12 that led to the miscarriage. He laughed it off saying I read too much on the internet! How can I get help with doctors like that 🙁

            Anyway I have hope in the PHD that things will improve and whatever caused my high TSH and CRP, probably an infection, will dissappear. Tests so far just haven’t found any infection.

      • (is your CRP test unit result in mg/L or mg/dL. was the test CRP or hs-CRP)

        be aware there are actually 2 types of CRP tests,
        when Ellen says “That is very high. c reactive protein should be under 1 for low risk. Under 3 for average risk”
        This is referring to the hs-crp test (hs=high sensitivity)…applies if the units are mg/L (not mg/dL).

        Hopefully your doc just did the ‘basic’ CRP test (probably the more common test in the 1st instance).
        …Tho you are still above range on this test as well, normal is less than 10 mg/L.

        see link below for more info, & it lists both units,

        • so as not to confuse…what i meant when i said “…applies if the units are mg/L (not mg/dL)”
          is that the hs-crp risk category numbers, 1 & 3 are for mg/L units. if the hs-crp test results are in mg/dL units then the risk category numbers are 0.1 & 0.3.

          anyway, all the info is in that link, for both tests,

          • I just checked my results and the exact CRP is 22 mg/L. So it looks like it is high then? If I understood correctly. I just noticed my albumin levels at the time were slightly elevated at 52 g/L.

            I’m hoping my levels are better now as my symtoms are less noticable but it’s still worrying not understanding what’s going on.
            Since stool test- which could confirm gut infection was quite good, and all the gynacology tests to confirm pelvic inflammatory disease or similar were also normal, So obviously something was not picked up by the tests I had.

  27. Lauren Chaney

    Hi Paul,

    I’m a 17 year old swimmer who would like to start on the “perfect health diet.” I’m not trying to lose weight, but rather, trying to eat more healthfully. In short, I started eating healthy at age 13 but was only eating a lean meat low carb diet, and it effected not only my swimming but my body. I found out about your diet through my dad whose read the book. I was just wondering if you could help me understand how much I should be eating with the perfect health diet because I need to make sure I’m eating enough to fuel my swimming and extra work outs I get in. I typically workout twice a day swimming or swimming and weightlifting each workout is approx. 2 hours long. If you could help me understand what I need to do I would really appreciate it. Thank you!

  28. Paul,

    What is the PHD position on limited use of Splenda, stevia, and other artificial sweeteners?


  29. Hi Paul,
    I’m looking for advice on a natural effective anti-inflammatory-
    my history –
    went GF at physians suggestion about 11 months ago as a hail mary to solve developing peripheral neuropathy and constant stomach issues, and VERY low vitamin D (despite being outdoors and eating some dairy).
    I had immediate results with Neuropathy, stomach settled down, vitamin D levels are up and my sinuses and a reoccurent face rash cleared up too.
    But about 6 months ago a few weeks after a foot surgery I developed another itchy face rash that I thought was a reaction to the medicine surrounding surgery BUT it never fully went away. I tried just about everything, changing cleaning products, make up, foods – everything is pretty clean and natural – rash would still not go away and flare for ascertainable reason…
    After several docs, I got to an Allergist and i was finally diagnosed with dust mite allergy and a chemical sensitivity, doing my best to remove those, but also have started experiencing terrible reactions to bug bites and in general tons of allergic inflammation–Doc has just put me on a step down 8 day dose or prednisone and I am also taking 7 days of bactrim for a cold (first one in 11 months) that turned into a sinus infection…More inflammation!
    But Finally with the prednisone, my 6 month face rash seems to be clearing…SO, can you recommend a strong natural anti -inflammatory protocol or supplements? I obviously will not stay on prednisone and I am confused b/c a lot of what I read says fermented foods and aged/slow cooked foods like bone broth have lots of histamines and I am afraid that will make my inflammation worse…I was thinking about Tumeric/Curcumin, and/or bromeliad? Querctin? I have a lot of the recommended PHD supplements/vitamins but have stopped most things b/c we could not figure out what was causing rash and everything became a suspect….
    Any opinions or experiences would be helpful. The allergist is hoping the prednisone will “reset” my overactive immune system – If successful I just want to help keep it from being overactive again 😉

    • Hi Anne,

      I don’t think you should think of this as a problem of “too much inflammation” but rather mis-directed inflammation. So it is not anti-inflammatories you want, but nutrients and stimulation to normalize immune function.

      Major influences on immune function include (a) vitamin A and vitamin D and vitamin K – do you get sunshine daily, eat liver once a week, spinach and carrots daily? (b) antioxidant minerals – zinc (oysters or supplements), copper (normally from beef/lamb liver), selenium (normally supplementation unnecessary), iodine (seaweed or supplements), (c) thyroid health – have your thyroid numbers been checked?, (d) polyunsaturated fats – do you eat seafood for omega-3 once a week, keep omega-6 down, but eat 3 egg yolks a day?, (e) extracellular membrane integrity – eat bone and joint stock and vitamin C, (f) circadian rhythm entrainment, intermittent fasting, daily exercise, (g) gut flora – some gut microbes promote inflammation or redirect it, others calm it down. Try taking probiotics known to reduce inflammation like Lactobacillus reuteri.

      Best, Paul

      • Thank you Paul,
        That is an interesting way to look at it and yes I have always had misdirected physical “over” reactions when I think about it.

        I will get back to the PHD supplements you mentioned. I had cut eggs back too b/c they were possibly allergic, but will get back to those. I am a small framed woman so I usually eat 2 chicken eggs or one large turkey egg. And I will bump up my spinach, carrots and my favorite oysters!

        RE Thyroid, Actually, I am on 10 MG armor thyroid for the last 3 months as my TSH was a bit high (though after going gluten free my T3 & 4 are normal) and my mom had graves disease. Will be getting levels rechecked soon….The low dose armor thyroid actually seemed to reduce the rash a bit especially on my neck IMO but it never fully went away and the endo did not think it was related…

        I was trying intermittent fasting but I tend to get hypoglycemic when I don’t eat frequently and when I used coconut oil to help this I felt like I was gaining weight. There was some info at Marks Daily Apple suggesting this happens to women sometimes so I am not sure how to incorporate fasting in my routine…what is the minimal fasting window that is beneficial ?

        I do get exercise and sunshine – intense pilates 3-4 times a week and dog walks/hikes daily and spin class sometimes. Over all, I am quite healthy and eat pretty well which makes the whole thing more frustrating. It sounds like you are not concerned about histamine levels in food then? (neither is my allergist if so, so that makes 2 of you).
        Thank you for your time and thoughts!
        SO very appreciated!

        • Paul is recommending egg yolks, which are the nutritious part of the egg. The whites are less important and can cause allergic reactions in some people. Discard the whites and eat 3 yolks per day.

        • I’m glad you mentioned that Mark’s Daily Apple discussion. I looked it up, and basically he says IF or fasting of any kind MAY be a stressor for women. I wonder if Paul has replied to this anywhere. Some of the women commenting on his post said they gained weight while IFing. I’ve been gaining for a couple years and only IFing for several months. My gain could be caused by something else. But I’d really hate to think it’s stressing my adrenals and possibly also adding to the weight gain.

          Like you I’m healthy, eat well, exercise, read up, consult health care practitioners, diligently try one thing and another–so, the unbeatable health problems perplex: almost more than I can continue trying to beat.


        • Hi Anne,

          If you get hypoglycemic during an overnight fast, odds are you didn’t eat enough carbohydrate (maybe protein too) during your previous day’s feeding window. Be sure not to undereat carbs and protein while fasting. Coconut oil is only a partial fix and it adds a lot of calories for every bit of relief.

          I recommend an 8 hour feeding window and 16 hour fasting window. Try eating more carbs.

          Histamine problems usually go away when you are well nourished, so I wouldn’t do anything out of the ordinary until after you have fixed basic nourishment.

          Best, Paul

          • Thank you so much, Paul.

            Eating more (especially carbs) is still so counter-intuitive for me…BUT I think you are right and will give that a shot.
            Thank you again for your great work and assistance!
            Happy 4th!

  30. Hi, I know that organic meats are best but when they are not obtainable because of cost, are in-organic still a good choice? I am particularly concerned about liver as I am trying to increase my folate levels before I become pregnant.
    Thank you

  31. I am new to the Oerfect Health Diet myself but my husband has done very well on it. I am now starting on it. I am a 60 yr old female that has been obese for 20 years. Christmas night I developed a pain behind my ear. With in 36 hours the right side of my face was paralyzed. 5 dats and 3 doctors later I was diagnosed with Ramsay Hunt Syndrime secondary to shingles in my right ear. I also had serious balance issues. Now 6 months later I an still hVing some balance issues but the paralysis is much better. In fact most if that side has tightening and spasms that have been pretty well controlled with acupuncture. At the onset the neurologist discovered white areas on my brain in two parallel lines parallel to the midline. He said possible Lyme disease which tests were negative or autoimmune also negative. I do not have migraines but he was concerned that it might be MS although he said the spots would usually be in horizontal distribution. He had the MRI repeated and said no change so not to worry about MS. I still have balance problems and perception issues with my right eye especially when I walk. Do you have any suggestions for me.

    • Hi Tina,

      I would do intermittent fasting (16 hours overnight, no solid food, drink black coffee, water flavored with lemon or lime juice, and vegetable soups made with bone stock, salt, and chopped vegetables). Eat a normal day’s food in your 8 hour daily feeding window, don’t undereat; and do all your eating before 8 pm. Get daily exercise and bright light in the daytime. Sunshine on bare skin for vitamin D. Liver weekly, egg yolks daily, spinach, carrots, beets for vitamin A and nitrates. Read our circadian rhythm chapter, chapter 42. Be well nourished, cook foods gently, eat a balanced diet.

      Let me know how you do.

      Best, Paul

      P.S. – You might consider coming to our October Perfect Health Retreat for more detailed guidance and experience living our advice. It is hard to communicate everything in words.

  32. I have a veterinarian working for me that has intense frequent migraines. She was diagnosed with hormonal imbalance. She is 37 appears to be very fit and has been a vegetarian–does eat dairy- since she was 20.

    I told her about your ketogenic diet.

    Any suggestions as she does not want to eat meat etc. I suggested trying to add coconut oil mct etc to diet and work on circadian rhythms

    Thank you for your help.

    • Hi Tina,

      I wish she would start by eating fish and possibly organ meats, and if she’s not already doing so, egg yolks. That alone might help cure her migraines and/or hormonal imbalance.

      The ketogenic diet is a somewhat risky diet and it becomes more risky when you reduce protein and some other fat-associated nutrients which are most easily obtained from animal foods.

      The circadian rhythm suggestion is a great one.

      In cases like hers it’s usually necessary to proceed in a step-by-step fashion with some experimentation and it’s hard for me to make recommendations secondhand over the Internet. Gut dysbiosis or SIBO and food sensitivities can be a major cause of headaches, and these are not uncommon on nutrient-restricted diets.

      Best, Paul

  33. Staring on page 400. Bone and joint stock.

    1) Is a ceramic crock pot with a glass lid OK?

    2) “d.” Leave the bones in the pot until the first batch is consumed?


  34. I am curious if you have ever done any research on tart cherry juice and if it fits into PHD. I started taking it to help with intermittent gout and I have found that I sleep better and I recover better from exercise when I drink one serving a day. But I am really trying to follow PHD…

  35. I am sorry, but I am confused – the weight loss protocol at one section of your web page (and in the book) suggest lowering fat from the standard PHD levels. At another point, and on this site, the fasting phase indicates one should eat coconut oil during the fasting phase.

    I am planning to start the PHD for health (I have had breast cancer twice, and I am overweight now, after the post-cancer meds) but I certainly think that weight reduction is a health-requirement. I cannot decide what to eat! I cannot decide what to buy to get ready for this program of healthy eating. Help, please. Thank you!

    • Hi Irene,
      It’s easy… Eat whole foods 🙂
      A good source of protein, vegetables and a starch (white rice or sweet potato).
      If you intermittent fast, just skip breakfast and eat some coconut oil to help get to your next meal.
      Also look in the recipe section.

    • Hi Pearl, (Not Irene – oops)
      It’s easy… Eat whole foods 🙂
      A good source of protein, vegetables and a starch (white rice or sweet potato).
      If you intermittent fast, just skip breakfast and eat some coconut oil to help get to your next meal.
      Also look in the recipe section.

      • Thanks – I am taking it that I am making this too hard??

        • Zaum,
          No, you are not making it too hard. I wish no one would ever say “it’s easy” about anything health related, because when it isNOT easy for someone, it feels like you’re just doing it wrong.

          I for example have long been doing the “just eat whole foods” thing with good protein, vegetable, and my PHD safe starches! I exercise, I go outside a lot, I eat a carrot every day and spinach every day and my 3 egg yolks etc. BUT I have not stopped gaining weight in my belly for three years. I’m going up one size every year.

          I am sitting here wearing a dress I only wear to weddings. So it’s like a gauge of how much weight I’m gaining. Today, the reliable dress feels so terrible, I came straight to the computer and sat down to search again for clues.

          What is up with my poor dear belly? Is it just perimenopause? I don’t know who can help me.

  36. I have a question that I hope doesn’t need extensive research. I would like to understand how to categorize raw green bananas and raw ripe plantains. Are they both considered starch? or fruit? I like to use them in my morning shake but don’t know how to count them. Do I use them as part of my safe starch or sugary fruit/veg? Also, are they considered Resistant Starch?
    Thanks for any help.

  37. Hi Paul,

    I would like to ask about varicose veins please. It runs in the family and a lot of people seem to get them. For me I am already developing them mildly in my 30s, mainly when pregnant.

    I am worried because my Mother has them very badly and had them checked by a specialist who told her she is at very high risk of developing a blood clot and they are considering doing laser treatment or some sort of glue treatment.

    Is there anything specific that can be done to help prevent or cure varicose veins? and reduce the chance of a clot forming? We are very worried as I just recently lost my Father to heart failure/pneumonia and now my Mother is in poor health. I haven’t found any specific information on this topic in your book or blog.

    Thank you very much.

      • Thanks Ellen, Yes I read on Dr Mercola that lack of Vit K can promote varicose veins. I myself have started to take it according to Paul’s doses and building up slowly since a week or 2 ago. But I am getting pain in my legs like I remember from previous pregnany when the spider veins start developing.

        • Do you think compression stockings would be beneficial to wear to help against varicose veins forming in pregnancy? This is what our UK doctors prescribe. If it’s not harmful I will probably try it.

        • Not sure if this would apply (just talking about leg pain, not veins); but when I get severe leg pain (very focal), applying pressure ++ with my thumb or finger on the same spot bit on the other leg relieves the pain.

        • Also, ask an ND if the supplement Horse Chestnut might be something that you could take to help varicose veins.

    • Claire,
      My story is the same as yours, except I’m in my 50s and have never had children. Mine are also spider only, but the veins did start appearing in my 30s or so as I recall. Like you, my mother has very bad varicose and has since delivering twins in her late 20s. She’s had them stripped a few times and at age 90 still wears support hose 24/7. So of course, I have the same fears as you. Plus mine are itchy and uncomfortable sometimes.

      Today I spoke at length with my dermatologist about varicose and spider veins and horse chestnut. (A very experienced Stanford MD, she’s also an internist, and while traditional/conventional, she’s very smart and open minded and knowledgeable about functional and naturopathic approaches.) I’d read that horse chestnut could be helpful and I saw several brands at Pharmaca today before seeing her. She does vein injections for patients with spider and/or varicose and she has recommended horse chestnut to patients over the years and says that over the period of a year or two with a patient, she has seen improvement, even when a patient was skipping treatments. She has both seen existing veins subside/fade/disappear and a reduction in the number and severity of new ones.

      This gives us hope!!!

      So next Monday I plan on discussing HC with my functional MD (who is working with me on other health issues) to get her opinion and make sure that there won’t be any interactions with the other stuff she has me taking. But I hope to start taking it, pronto.

      One of the readers mentioned K2. I take Jarrow MK-7 (and lots of Vit C) daily, but I haven’t noticed a difference, though it probably takes time. How many are you taking? Maybe I should be taking more than 1 daily, as I know Paul says “or more.” I’ll look at the Mercola article to see about his recommended doses for this condition, unless Paul wants to weigh in on this? 🙂

      Here is a very interesting article posted on the WAPF website that you should check out. It’s one of the best write-ups I’ve seen on cause, cure, prevention. The author makes specific product recommendations:


  38. Hi Paul,

    I have a couple questions:

    1) I’m a bit confused about what you think about Multivitamins, in the book you do not recommend them, but in your website, in the Supplements page (http://perfecthealthdiet.com/category/supplements/), you recommend taking Multivitamins at the end of the post, could you please explain? (I’m currently taking Dr. Mercola’s Multivitamin)

    2) Do you recommend taking Probiotics? Are they necessary?

    Thank you

  39. I know that their are many very smart people who read this forum, thus my question: My husband and I have both developed neutropenia. Our doctor is amazed that we should BOTH have it, and asked me if I had perhaps any cooking pots or dishes with lead in them. I don’t.

    Personally, I have had trouble for a few years with neutropenia and it was thought it was due to antibiotic treatment for a tick born illness. After stopping the medicine, however, my white blood count did not come up to the normal range.

    In January 2014 I managed to get it back up to the normal range after taking up rebounding (4.18; range 4.00-110.80). Last blood work was done in June, and it was back down (3.25), but I had not been diligent with the rebounding either. I did it a few times a week, whereas before I rebounded daily.

    Here’s the kicker: My husband’s started going down last year, and on 12/21/13 was 3.61. Doctor thought it was due to his giving blood, which he did regularly, so doc asked him to quit until his next blood work. That took place on 7/12/14, but the WBC showed lower still at 3.39.

    We are great walker and hikers. Do lots of outdoor work on our property too. We eat PHD, and frankly cannot think of any reason why this should be happening. Our other blood work is normal.

    Does any of you smart folks out there have any ideas? I’ve researched it myself and cannot find anything that would solve this riddle.

    We DON’T want it to continue to drop.

    Thanks! 😛

    • Hi mul,

      You seem to be quoting white blood cell count, not neutrophil count. If the diagnosis was neutropenia you might provide those numbers too.

      Generally speaking, lower white blood cell counts are good. Your body only makes white blood cells if it needs them, so if you have no infections and a beneficial gut flora, your WBC count will be low. Generally, the lower WBC count, the lower mortality is. Here’s a paper on cancer risk vs WBC count: http://www.ncbi.nlm.nih.gov/pubmed/16432087. Here’s all-cause mortality: http://www.ncbi.nlm.nih.gov/pubmed/16730736. Cardiovascular mortality: http://www.ncbi.nlm.nih.gov/pubmed/15767524. Note that people with WBC count of only 2.5 still had very low mortality, much lower than people in the “normal” range.

      So one possibility is that you’re just very healthy. If you feel good then that’s more likely.

      Another possibility is infection, which might have passed from you to your husband. Here is a discussion of infectious causes of neutropenia: http://www.uptodate.com/contents/infectious-causes-of-neutropenia. You should consider whether you might have any of those diseases, or have been exposed to them. For example, brucellosis can cause neutropenia, and you can get that from cows by drinking raw milk.

      You should tend to nutrition – try supplementing vitamin B12, make sure you eat beef or lamb liver weekly – and circadian rhythm entrainment, and have your doctor check out other possible causes.

      Best, Paul

  40. Hi Paul,
    I was wondering if you recommend intermittent fasting for someone who has adrenal fatigue and/or thyroid issues? And do you recommend any tweaks to your diet for that condition?
    Thanks. I respect your insight greatly.

  41. Hi Paul,
    I am a healthy, active 27 year old and have been diagnosed with alopecia which is progressing to nearly all hair lost on head and significantly slowed growth of body at over the last 9 weeks. Blood tests have all come back WNL and my doctor feels diet is not likely to make a difference, that I may have an underlying systemic autoimmune disorder (AI disorders are prevalent in my family- in addition to hair loss I have dry skin, am always cold, and will have random joint pain). He is sending me to a rheumatologist, who I will see in 4 weeks, with the thought of a DMARD (disease-modifying antirheumatic drug) being the answer. I have not had any significant reactions to my diet in the past. However, it seems to me that diet could make a difference based on what I’ve read. I am 12 days into a strict 4 weeks of the AIP diet with the plan to reintroduce foods and progress to the PHD as a more long term plan. Do you have any suggestions or thoughts of what else could be affecting my body to cause the hair loss/lack or growth- i.e. infections, nutrient deficiencies? Also do you feel the PHD could be an appropriate answer to reversing the hair loss?
    Thank you for your time and thoughts!

    • Hi Allie,

      I think PHD is a good approach, it is minimally toxic and highly nourishing and tends to support a good gut microbiome, all ingredients you want for avoiding autoimmunity. Often alopecia flares with stress and with high carbs, suggesting it is a gut bacterial disorder. Be sure to do circadian rhythm entrainment, intermittent fasting, daily exercise, and restful sleep in addition to good diet.

      Best, Paul

  42. Recent article by Elizabeth Kolbert in The New Yorker makes light of paleo diet. I sent the mag this note, but someone should write and really let her have it in the letters section of the publication.
    Re: Stone Soup by Elizabeth Kolbert – I suggest a reading of The Perfect Health Diet, by Paul and Shou Ching Jaminet. I’m not sure how ‘the environment’ will react to your use of the knowledge, but your children will benefit from it.

  43. hi Paul et al,
    just saw the question below on another forum (with no responses as i post).
    which seemed like an interesting question.
    anyone got any thoughts…? thx

    “My OH25 levels are really low below range, at like 7-8 (severe deficit below 10), while my 1,25 levels are in the middle of the range, about 35 (range 18-78).

    Tell me how I need supplementing with vitamin D if my 1,25 levels were ok on the test?
    If the active metabolite is in fact 1,25, this means all that OH25 does is convert to 1,25. If I have enough 1,25, how do I need more vitamin D? how is it a problem?

    Also, i’ve read that you can block your vitamin D receptor by supplementing vitamin D when you don’t need to, which can lead to a mirriad of problems.”

  44. Hi Paul,

    Big fan of your site. Hoping you may be able to provide some clarity- After a breath test came back positive for hydrogen, I took one round of Xifaxan for SIBO, which didn’t do anything for my chronic bloating, constipation, brain fog, and fatigue issues. Oddly, the only thing it did was eradicate the foul rotten egg smell from my gas. My subsequent breath test came back negative for both hydrogen and methane; however, my doctor thinks I should take Xifaxan/Neomycin for 14-21 days, as he believes I may have hydrogen sulfide producing bacteria, which the breath test doesn’t measure. I’m really nervous to take the Neomycin as I don’t have a confirmed positive breath test, and I would hate to make matters worse by further reducing my gut flora. Would you recommend trying an anti-fungal first, just to see if Candida may be at play here? Also, do you think an herbal treatment with Caprylic Acid and Oregano oil would have roughly the same impact on my gut flora as the Neomycin (being as it’s only about 5% absorbable)? If hydrogen sulfide producing bacteria were still present, I’m confused as to why the smell would be gone, but my symptoms remain. Thanks for your time!

  45. I loved your interview with my girlfriend Wendy Myers. I am the friend she mentioned in the interview that knows your book practically by heart! As a Nutritional Balancing practitioner, I have begun working with someone who has a history of severe Reflex Sympathetic Dystrophy. She also has some secondary autoimmune diseases that have emerged due to the severe stress that the disease has had on her body. I know you write in your book that the intermittent or 8/16 fasting is not okay for someone with ALS. What is your experience with neurological disease such as RSD? Is the 8/16 fasting optimal for her with her neurological disease or wisest for her to avoid? Thank you for any guidance you can give. A. Van Halsema

  46. Hi Paul,

    My husband and I don’t eat shellfish. Do you have a recommendations for foods that we can use to replace shellfish on the PHD?

    Thanks so much!

  47. The deaths of Philip Seymour Hoffman and Robin Williams are particularly depressing because both of these brilliant individuals had successfully stopped their addictive behaviors for years before again succumbing to them.
    I wonder if PHD could have saved them. Maybe it’s very difficult if not impossible to control addictive urges, when one has the means to satisfy them, if certain key nutrients are missing or in short supply? If ideal nutritional status were key in taking away the power of this type of runaway behavior it would certainly be a another happy consequence of PHD.

  48. Over the past several years, there’s been an accumulation of studies demonstrating that supplemental vitamin C/E seem to interfere in mitochondrial biogenesis, and thus prevent some of the health and fitness gains one might expect from their exercise pursuits. I was wondering how you might reconcile this with your recommendation to consume rather high supplemental antioxidants? Thanks.

    • will do a blog post on that sometime. Basically, too little of those is very harmful to muscle. You want an optimum. The optimum increases with age or ill health. inhibition of mitogenesis is a tiny effect not seen in every study. It is easily overcome by slightly harder training. Unless you are trying to win an Olympic gold medal, it is meaningless.

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