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. Dear Paul,

    Following PHD, Thanks for all your work to improve everybody’s health.

    I live in Europe, and blood tests reveal hypothyroidism. Slightly higher cholesterol than normal, not enough white blood cells, and low red blood cells. My BMI has always been very low. I got many gut problems (constipation). Here in Europe, TSH is the key to be prescribed thyroid hormones, so my TSH results are not enough higher. But reading your posts make me think hypothyroidism is to be fixed. (TSH : 3.7 T3and T4 too low )
    What kind of supp or food would you recommend ? can egg yolks or cholesterol rich food bein eaten despite higher cholesterol…?
    I feel so afraid not being able to fix all those issues without help : could you help, and tell me whether those could be cured with PHD ? So upset and sad.
    Thanks so much.


    • Hi Sarah,

      Yes, those conditions can be fixed, though gut problems can be highly variable in how long they take. Hypothyroidism usually improves gradually and is cured over 6 to 24 months. If you can get replacement thyroid hormone, you would feel better immediately. You should present your doctors with papers showing the damage of TSH of 3.7 and that thyroid hormone reduces mortality in such cases.

      Good steps to take first:
      – Eat liver 1/8 kg/week, green leafy vegetables daily, orange-yellow plants (carrots, sweet potatoes, orange fruit) daily, beets often, 3 egg yolks daily
      – Get sunshine on bare skin daily; supplement vitamin D when you can’t
      – Eat bone/joint/tendon stocks in soups and stews daily or near daily, supplement vitamin C
      – Supplement a low dose of iodine daily, we recommend 225 mcg. If this gives trouble at first, start with a smaller dose and work up, for example by cutting pills in half.
      – Work on circadian rhythm entrainment
      – Daily intermittent fasting with a 16 hour fast will help heal the gut but you must be very careful not to undereat. Your symptoms are consistent with undereating right now and when women fast they tend to undereat even more. Try eating as much food as you can in an 8 hour daytime feeding window, but only natural whole foods.
      – Daily exercise. Do both strength and cardiorespiratory exercise.
      – Eat fermented vegetables to replace gut microbes
      – Eat your starches (potatoes, white rice) cooked and then cooled with overnight or longer refrigeration before eating.
      – Look up our constipation post and follow steps there; also supplement taurine to support bile conjugation.

      Finally, ask your doctor to do a stool test to look for gut infections.

      Best, Paul

      • Hi Paul,

        If you eat 3-5 gramm iodized table salt per day, is supplementing with iodine still necessary? Thanks!

        • Hi Mark, iodized salt is typically 0.0002% to 0.0007% iodine (http://www.saltinstitute.org/news-articles/iodized-salt/), so 3 to 5 g salt would have about 6 to 35 mcg iodine. You need about 40 mcg per day for production of thyroid hormone and then there are other uses of iodine. So this is really only enough to prevent extreme deficiency conditions like mental retardation in children. I don’t consider it close to optimal. It is a low enough amount that it is riskless even probably for those with hyperthyroidism.

      • When you say “Eat liver 1/8 kg/week”, do you mean any kind of liver, or ruminant? You describe elsewhere the differing benefits of liver from (for example) cow, versus liver from fowl.

      • Thank u so much Paul !!
        Is there a risk of mortality in this case ? ? It´s a long time now inve felt those symptoms. It´s because îve asked fir a blood test i’ve noriced all those issues
        As i crave for liver can it be eaten more often ? And what about jelly when not ar home for making bone broth..? Are you confident for my case to be cured?
        Thanx , be blessed

  2. Paul,
    I’ve noticed in your replies to blog posts about high TSH that you usually recommend that people pursue thyroid meds with their doctors and not wait for the body to correct itself over time by following PHD. My TSH was 3.5 in Jan and now it’s up to 4.2 and I’ve been following PHD pretty closely (though not supplementing with iodine because I was trying to use seaweed instead — the Fukushima fallout has scared me away from this a little, so I’ve backed off and need to start taking iodine).
    My functional doc is not recommending thyroid meds right now because she thinks that my TSH will come down as we improve all of my hormone pathways by addressing other issues (high homocysteine, methylation issues, dysbiosis, adrenal fatigue, stress management and others). I’m awaiting the results of a salivary cortisol test right now. But is your opinion that I should push for thyroid medication and not wait for my body to “normalize” on its own?
    I know that your book says that under 1 is ideal and I’ve heard others say b/w 1 and 2. It sounds like in your opinion, letting TSH be 4.2 for any length of time poses serious health risks? Thanks, I’m trying to figure out if and how hard to push my doctor on this.

  3. hi Paul

    in response to Sarah, you suggest refrigerating cooked starches at least overnight before eating…what is the purpose of this?

    is it beneficial for all of us to do this?

    thank you


  4. Hi Paul,

    What are you thoughts on adrenal fatigue? Do you consider it to be a legitimate condition?

    • Sure. The technical term is “adrenal insufficiency.”

    • Kenneth Holland


      If I may weigh in, I was diagnosed with Adrenal Fatigue about 6 months ago. I took several tests including an ‘Adrenal Stress Profile’ test that showed among other things that my adrenal glands were not producing enough cortisol. After being on treatment I have improved markedly. I have much better moods and my digestion has improved (although let me add that fixing your Adrenals won’t fix your digestion if you have a bad diet, lifestyle, etc…).

      Paul can weigh in on this more expertly, but my treatment is also aimed at bringing my hormones in balance as well.

      There’s a lot to this but let me say it is very real.


      • What was your treatment, if you don’t mind me asking?

        • Kenneth Holland

          I am on a daily regimen of Pregnenelone and DHEA along with Adaptagenic herbs. I also follow a Paleo diet and safe starches. I was also tested for SIBO and was negative, which is important to know.

          Definitely see a doctor before you embark on these protocols.

          • Thanks for the responses. I took the 4 time/day cortisol/DHEA saliva test, and it said my DHEA was within range; however, my cortisol was low at certain times and high at others. My doctor recommended adaptagenic herbs.

            I’ve been doing PHD diet and supplements for a couple of years, and I’ve been doing rhodiola for a few months. Unfortunately, I haven’t seen much improvement. My midsection always has a cramping feeling; it hurts when I push in my stomach, and it’s hard to get a good breath. Also, I’ve noticed significant hair loss over the last year, as well as a constant aching in my neck. My LDL cholesterol is usually in the 200’s.

          • Kenneth Holland

            Hi Daniel,

            I know how frustrating this can be.

            Did you test for any infections (SIBO)? If you don’t address that then you’ll keep having issues.

            My practitioner said (if I remember correctly) that even if the DHEA is in range taking DHEA (along with Pregnenelone) can be crucial in improving your cortisoland balancing your hormone profile.

            Again, I would make sure to rule out infections. I hope Paul can weigh in on this.

          • I have not tested for SIBO. However, because I supplement with SBOs, resistant starch, and fiber, I’d be surprised if I had it.

  5. Paul, what are your thoughts on Adrenal Fatigue? Do you consider it to be a legitimate condition?

  6. Dear Paul,

    I have been diagnosed with hernia, what nutrients are especially important to stop the negative development and ensure healing after surgery?


  7. Hello all,

    I have very much enjoyed reading PHD. I have a few questions regarding some recent blood work I had done. Some background: I am a 57 year old vegetarian (I eat eggs and dairy) female, who exercises 5-6 times a week, and makes a concerted effort to get significant protein and healthy fats to try and replicate the PHD as much as possible without eating meat. Despite having a healthy weight and other healthy biomarkers, my glucose serum levels continue to be outside of the normal 65-99 mg/dL range (mine are around 105mg/dL. This concerns me, as I eat fairly low carb (no grain or sweets).

    Is this something I should be concerned about? What are some modifications to my diet that could help return my numbers to the normal range.


  8. I have many symptoms of poor gut health, can someone recommend most comprehensive test that will cover SIBO, leaky gut, pathogens, yeast overgrowth etc? Thanks.

  9. One thing I haven’t been able to solve on PHD is the terrible allergies I have. Specifically, I have perennial allergic rhinitis, almost 90% of the time I have a mind-numbing sinus headache and congestion. It seems to be triggered every time I eat. After I eat, I also get severe post nasal drip that causes me to gag and dry heave. Nasal sprays and anti-histamines don’t help. I’ve tried every natural and non-natural remedy, I’m now thinking about trying a fecal transplant even though I haven’t seen any studies on this being effective. However, if allergies are caused by an over-active immune system and 80% of the immune system is in the gut (or so they say), wouldn’t logic follow that a fecal transplant should be effective? There is more an more evidence that comes out each day connecting gut health and microbes to allergies, it would seem to make sense that this would be beneficial. ANy thoughts or am I way off?

  10. Hello Paul ! A lot is written about the benefits of grape seed flour. δd like to test it but is it PHD compatible !? Is it low omega 6 and a kind of safe starch ? Thanks a lot ´

  11. In a rather well done (IMO) study, these authors (http://ajcn.nutrition.org/content/87/1/142.full) claim that Vitamin C (and other antioxidant) supplementation 1) inhibits the natural training efficiency for endurance athletes, and 2) blocks the natural anti-oxidant enzyme production naturally occuring with aerobic exercise. Another publications which cite them also claim similar results although I only have access to the abstract for that (http://jp.physoc.org/content/592/8/1887.abstract)

    My question: Do you think I should stop Vitamin C supplementation considering I am trying to build my aerobic capacity to the point of being able to win races in my age group starting next year (40)? I have noticed that over 2 years, my running speed at a fixed heart rate of 130 bpm has not increased lately (went from 11 min/mil to 10 min/mile in 4 months but stagnant since).

    I am pretty much on the perfect Perfect Health Diet for the last 2 years and take all the recommended supplementation. My weight is great. My blood work is great (high cholesterol but my HDL/total ratio is 3.0 and triglycerides < 70).

    • Hi Matt,

      No, I wouldn’t stop vitamin C. Vitamin C improves exercise adaptation in those who are deficient and there are as many studies showing it does nothing to stop adaptations in excess as there are ones like you cited. Even if it did, the effect would be very small. I think you should look to changes in training to improve running speed, e.g. work in some sprints.

  12. Hi Paul. I’ve always had low CO2 when I get blood tests. No doctor seems alarmed. But I have a hard time breathing in exercise situations and my stamina never seems to approve beyond very poor. Does this mean anything and what can I do to improve my cardio stamina?

  13. Hi Paul,

    What are your thoughts about the lectins in Rice, Potatoes, and Tomatoes?

    I have read an article in which it says these 3 foods may be as inflammatory as Wheat. Is this true?

    Rice and Potatoes are the safe starches of PHD, does lectin in these foods have any importance?

    Thank you,

  14. Hi Paul,

    Are you familiar with the supplement MegaHydrate (by Patrick Flanagan)?

    If so, what do you think about the importance of H- ions as antioxidants, and also making the water wetter by lowering its surface tension for optimal hydration?

    It seems like water is taken for granted, and many believe all water is the same, turns out it might be the most important “nutrient” we put in our bodies?

    Thank you,

  15. Hello,

    I am confused about how exactly one can tackle infections that are causing mental health problems. Thanks

  16. Hello Paul,

    I am a bit confused about supplementing Copper. I do not like beef/chicken liver so I don’t eat it. I do eat dark chocolate (%80 dark – 28 g/day).

    In addition to chocolate, should I eat nuts (especially cashews since it’s the highest in copper) everyday to get enough Copper a day? If yes, how much cashews should I eat a day in addition to 28g chocolate?

    Or should I just take a Copper supplement because I’m not eating liver?

    Thank you,

    • Hi Jo,

      Yes, nuts/cashews would be a good addition to the chocolate, in moderation. You might try calculating your copper intake over a representative 3-4 day period and see if you are averaging 2 mg/day which is a good target. If you are short, a 2 mg supplement every other day, or a few times a week, should be enough.

      • Thank you for your answer Paul,

        In your book you mentioned:

        “Due to evidence for toxicity from inorganic copper in supplements and the importance of eating liver for its wide range of beneficial nutrients (such as choline and trace minerals ), we recommend obtaining copper from food with one of the following two strategies…”

        Do you mean all Copper supplements are risky or there are good and bad quality ones? I was going to buy Solgar’s Chelated Copper 2.5 mg, is that okay? I’m just going to take the supplement if it’s okay instead of eating the nuts and dark chocolate everyday, if it is not toxic?

        Thank you,

  17. Hi Paul,

    I’m a bit confused about what you think of Soy. In the book you do not recommend it, but you include Soy Sauce in some recipes too.

    So you do not recommend unfermented soy products, but you recommend fermented soy products like soy sauce? If yes, do you mean fermented soy products do not cause the same issues unfermented soy causes that you mentioned in your book?

    Thank you,

  18. Hi Paul/Anyone
    I’ve been doing Chris Kresser’s 30 day reset and on day 8. I have an underactive thyroid with a TSH currently of 9.78 and in June it was 0.03. The doctor said my thyroid went from under to over to under again! I am doing the intermittent fasting and eating in an 8 hour window every day. This is supposed to make you sleep however I only sleep for a few hours (4 max) and am wide awake with nausea/hunger. I am a bit confused about the strict paelo as I am eating sweet potato but not every day so asking the question if I should eat every day or at least have some white rice as I also read that too strict paelo is not good for underactive thryoid. Maybe someone can clarify please.


    • Hi Shaz, Yes, you need far more carbs. Sweet potatoes have only about 227 calories per pound so if you are not eating them daily you are probably getting at most 50 calories per day on average from them, which is about 1/10 what you need.

      Sleeplessness is a common symptom of starvation.

      Your thyroid pattern is also not uncommon, there is hypothyroidism plus an injured part of the thyroid (nodule) which converts iodine to thyroid hormone in unregulated fashion leading to hyperthyroidism when you give yourself iodine.

      You should consider coming to our retreat.

  19. Hi Paul,

    Do you recommend taking Probiotic supplements regularly?


  20. Wondering if there is a particular stance on the use of yeast for baking and if maple syrup is any sort of alternative to sugar or is it the same
    Thank you

    • Susan, in their book, pg 103, they state that they favor glucose only sweeteners (rice syrup, tapioca syrup and dextrose powder). It also says it’s ok to combine them with honey or sugar to get to 80% glucose. I don’t believe they recommend maple syrup. I don’t know about the yeast.

    • Yeast for baking is fine, though we don’t encourage lots of baking because natural whole foods are better than flour-based foods. We would favor honey over maple syrup, dextrose among powdered sweeteners.

  21. Hi Paul

    I’ve just learned that I have a Blastocystis hominis infection. (I had a comprehensive digestive stool test.) I’ve suffered from IBS symptoms (constipation and abdominal pain) which have been getting worse recently, together with acid reflux, low energy and intermittent anxiety and depression. All the other results from the stool test (gut microbiota, digestive function, etc) were excellent and there were no other infections from yests, bad bacteria or parasites. I’d prefer not to take antibiotics to get rid of the Blastocystis, especially as I’ve heard they often don’t get rid of the parasite permanently. Do you have any suggestions? BTW I’m one of those people who did terrivly on Very Low Carb – now I know why!

    • Hi Mary Elena,

      I’m glad you’ve found the source of your problems! Unfortunately I am not knowledgeable about how to deal with this one. Hopefully your doctor can help. If it were me I would get treated.

      Best, Paul

    • Look up Dr Daniel Kalish. He seems to be an expert in dealing with parasitic infections.

      • Thank you for that suggestion, Claire. And thank you, Paul.

        • You’re welcome. I looked into it as I was considering that I have a blast infection. I did one stool test and it found near nothing wrong, just slightly low levels of some beneficial bacteria and near perfect digestion.
          I’m now waiting for results of another labs stool test.
          All my symptoms started with a bout of food poisoning a year ago. I feel weakened, I get bouts of fatigue, anxiety, I’ve had rare episodes of diarrhea with low down abdominal pain, had a couple of bouts of strange joint pains (my hips felt ‘loose’). Then I had some urigenital symptoms a bit like a UTI but cultures showed no bacteria. I seem to be over that now but now have just experienced 2 nights of uncontrolable shaking and some thirst. Temperature was only 97.16F/36.2C. Scary. It seems to settle down when I eat. I’ve realised that my appetite has been low so perhaps I haven’t been eating enough and I got hypoglycemic? I’ve never had blood sugar level problems before. Just over a month ago I was tested for fasting blood glucose and I had good levels. Since then my head doesn’t feel right- sort of slightly dizzy and I’m tired during the day even after a full nights sleep.
          No idea what is going on. All my blood results I’m told are near perfect. Even my CRP has gone down to <1 (perhaps due to serrapeptase that I took for a bit?). Even my TSH has improved by going down from 4 to 2. Just that I am a bit anemic but my ferritin was fine (if not a bit high according to Dr Mercola).
          It's great you found out your cause. I just pray I find my cause too.
          I just don't know what other tests to do if this stool test finds nothing. Some days I'm struggeling to cope and have 3 little ones to look after.

  22. Hi Paul:

    What’s your take?: Processed meats with sodium nitrate or celery salt; meats with celery salt as you may already know, are higher in nitrates but are free of antibiotics and are uncured; this begs the question of which option is less toxic?: higher nitrates and uncured meat, and antibiotic-free meat OR lower nitrate concentration and antibiotic injected meat and cured meat. I hope to collect your insight, thoughts, and comments.

  23. Hi Paul,

    Would you recommend eating Smoked foods (like smoked salmon)? Or you consider them carcinogenic?


  24. Hi Paul, currently reading and enjoying your PHD book.

    Just a question on how one arrives at the “perfect” macronutrient ratios, based on how Paleolithic man ate:
    Most wild animals contain very little fat – even if you eat the whole animal including organs (which comprise a relatively small % of the total weight) it would predominantly be muscle protein and at most an equal ratio of protein to fat.

    How do you reconcile this with a recommendation of at least 50% of calories from fats? Did hunter-gatherers simply throw away a lot of the muscle meats? This would make little sense in a world where food was scarce, wouldn’t it?

  25. Hi Paul,

    I’ve been following your blog for the last few days and finished your book recently. I’m a little chubby, suffer from depression, anxiety, hair-loss and very frequent cold. I also have gut problems. I want to start your diet, but before starting it I want to know if the ketogenic version will be better for me or the normal version? Also, do I need to take all the supplements mentioned in the book?

    Thanks ,

  26. Hi Paul,

    Is Sesame Oil allowed in PHD? It is included in the mayonnaise that I buy along with Coconut Oil and Olive Oil.


  27. Hi Paul,

    While buying supplements I’m facing a problem that sometimes 2 or 3 of them are combined together in a single capsule(like zinc, magnesium and copper). Is it a must that I take each mineral/vitamin separately or can I take them combined if the proper dosage is maintained?


  28. Hi paul,

    I’m a little confused about one of your recommendations in a previous blog post (omega-3 fats and cancer July 14 2013), and I’d appreciate it if you oould clariy.

    “Eat enough oily marine fish to achieve omega-6 and omega-3 balance;
    Minimize omega-6 intake so that omega-6 and omega-3 balance is achieved at the lowest possible intake of polyunsaturated fats.
    All nutrients can be eaten in excess, and omega-3 fats surely fall into this category. The right amount of oily fish is probably about one to two meals per week.”

    However if, as far as I can see, shellfish, freshwater and marine fish are the only sources of food with a positive omega-3 to omega-6 ratio. So, unless these are eaten on a daily basis, or the omega-6 would exceed omega 3 unavoidably with other daily staples such as all animal meats, eggs, all cooking oils, which have a positive omega 6 ratio

    If there is a possible health risk from excess dietary omega-3 and the recommendation is to limit intake of oily fish to once or twice per week. How is it possible to achieve the 1:1 omega 3-6 ratio, since (it seems to me that) all other foodstuffs, have a higher omega6 ratio?

    What other proteins would make up the remaining 19 meals of the week when salmon/mackerel/sardine.. is excluded without exceeding omega-6 levels

    Hope you can clear up my confusion

    Thanks in advance


  29. Hi Paul, It would be so great you plan an article on specific hormon problems dedicated to womens’ health…How can food affect our oestrogen level,which plant or food can help in all this “specific world”… related to that, I wonder if you noticed in thyroid or endocrin issues an emotional link and what are the tips you can give with the all experience you’ve collected so far. Best, Maya

  30. Can you tell me what fats 40-50-60% translate to in a few examples. Like butter or coconut oil is how many tablespoons?

    • What helps me is using an online food diary. If you search you’ll see there are several options. So when you type in what you ate for breakfast, lunch, or dinner, it will tell you how many calories per unit. And as you continue for a few days, you’ll learn the general calories and percentages yourself.

    • My favorite online application is using Cronometer, it’s very flexible, and you can set your own goals for numerous vitamins and minerals, as well as the usual macro nutrients & ratios of pro/carb/fat. It’s at: cronometer.com

      • In following the PHD what do the fat recommendations translate to in measurements? The other recommendations are broken down in weight per day.

    • In following the PHD what do the fat recommendations translate to in measurements? The other recommendations are broken down in weight per day.

  31. Is Barley Malt Syrup equivalent to Brown Rice Syrup?

    Is Rutabaga a “safe starch”?


  32. Hi Paul,

    If the Astaxanthin in a Krill Oil supplement is high enough (500 mcg per capsule), do you think it will prevent it from going rancid?


  33. Hi Paul
    I’ve been taking a prostate formula to combat ‘benign prostatic hyperplasia’. Whether I still have this, or ever did, is indeterminate, but I did have trouble urinating at times in the past. Now that I’m following PHD, that may be the reason I no longer have those symptoms, but I don’t mind continuing to take the formula just as insurance – if it both may be beneficial and isn’t likely to be harmful, that is..
    Do you have an opinion about these ingredients in the prostate formula?
    Thanks for any advice.

    Serving Size 2 softgels

    Servings Per Container 30

    Amount Per Serving
    Saw Palmetto CO2 extract (fruit) [providing 272 mg total fatty acids]

    320 mg

    Graminex® Flower Pollen Extract™ (from rye)

    252 mg

    AprèsFlex® Indian frankincense (Boswellia serrata) extract (gum resin) [providing 14 mg AKBA†]

    70 mg

    Pumpkin seed oil [providing 170 mg total fatty acids]

    200 mg

    Stinging and Dwarf nettle extracts (root)

    240 mg

    Pygeum extract (bark)

    100 mg

    Lycopene [from natural tomato extract (fruit)]

    10 mg

    Beta-Sitosterol (from pine)

    180 mg


    160 mg

    Proprietary Enterolactone Precursors Blend [HMRlignan™ Norway spruce (Picea abies) (knot wood) and Flax (seed) lignan extracts]

    20.15 mg

    Boron (as Albion® bororganic glycine)

    3 mg

    Other ingredients: gelatin, soy lecithin, glycerin, sunflower oil, purified water, soy fatty acids, carob color, maltodextrin, beeswax, rosemary extract.

    Contains soybeans.

  34. No Soap. This was my dad’s expression for a situation with an unsatisfactory outcome. But it doesn’t seem to apply to my experiment of stopping the use of soap and shampoo, since reading the article in the NY Times about the benefits of allowing beneficial natural skin bacteria to coexist with us.
    I’ve been bathing in non-chlorinated water while using a microfiber cloth to simply rub myself clean, and so far so good. I can stick my nose right into my armpit and not detect anything nasty. The bath water gets grayish/cloudy, but a quick swipe of the same cloth and there’s no bathtub ring – everything drains along with the water, so no chemicals are needed for tub cleaning either. For my hair, I just wet it and use a brush with a combination of plastic, round tipped stimulating bristles, and natural boar, cleaning bristles to clean the scalp and hair shafts while bringing the natural oils up from the hair bases onto the shafts.
    Unless the people I’m in close contact with are just polite and kind, or I’m as completely invisible as I sometimes feel, nobody seems to have detected my dirty secret.

  35. Like many people, I’m a generalist. I’m very happy allowing someone to do the hard slogging and then grabbing the benefits for myself before moving on to another subject I may find interesting. And I’ve been following the Perfect Health Diet for more than 2 years and enthusiastically recommending it to my friends.
    I gave the book a thorough reading, took notes, made supplement lists and purchases, organized my kitchen and bought necessary implements, and followed the advice and the pre and pro scriptions fairly consistently albeit with occasional lapses for variety, and gained immediate benefits including almost complete resolution of my digestive problems.

    Currently I’m at a vacation apartment in Croatia where, because I’m now retired from my job, I’m able to spend a couple of months every year. When in this situation in which the normal activities and distractions of life are absent and unavailable, I use the opportunity to pay attention to details that I usually ignore – and on this trip I brought a copy of the PHD book along to give to a friend who didn’t turn up.
    Because I brought very little else to read, I began to re-read PHD like someone in grade school – painstakingly pouring over each sentence and making sure that I really understood its meaning. It’s very easy to read something fluidly and rapidly, but quite another to stop and check your understanding, go elsewhere to resolve mental conflicts and confusion and create cross connections and mnemonic devices, making the information sort of organically connected to the other facts you already know.
    I had previously thought that I was following the PHD, but found that I’d only been following parts of it. I was surprised at how many specific facts and recommendations I’d missed. I’m still reading, and re-reading, the book in very short chunks, maybe a chapter or two, or sometimes just a couple of pages, at a time. And surprisingly, each reading teaches me something.
    I think that a quick read of PHD and then putting what one remembers into practice will help virtually anyone’s health. But to really move toward perfect health, I would encourage PHDers to not be embarrassed to take a very detailed interest in the diet. Just one reading of the book is not enough to assimilate what it offers, and what you need. Even though you wouldn’t think of trying to drum the knowledge into another person’s head, drum it into your own. Pretend you’re going to be tested on the material, and that your grade matters. Because for the sake of your health, it does.

  36. Hi Paul
    I wanted to ask once again about water. Somewhere on the site I think I read that you were agnostic about the need to filter or distill water and about the benefits of consuming mineral water. And I think you said you use a pitcher or faucet type filter, which by design cannot remove everything. In another more recent post I think you said that our paleo ancestors drank mineral water. Given these takeaways, I’m a bit confused.
    It seems to me that the term ‘mineral water’ is pretty non-specific; any minerals, in any amounts, could conceivably adulterate water in this vague category. Another source of my confusion is that the contents of natural water sources can vary considerably, both now and undoubtedly in the paleolithic as well. Karst topography, or rapid glacial scour flow for example, where water percolates through limestone aquifers for great lengths of time and distance or at high speed over pulverised strata before emerging, can carry lots of mineral, whereas many other and much more extensive landform areas with adequate rainfall may have free flowing bodies of water which have inadequate detention time for putting minerals into solution, even assuming there are given minerals in soluble form in their basins, which itself is not a given. You’ve advised that it’s unwise for us to supplement calcium in the diet, but why would drinking whatever amount of mineral a natural water supply may contain be of little concern?

    Another thing nagging at me is the feeling that you may have unintentionally over-discounted the potential danger of manmade chemicals in our water supply which, correctly or incorrectly, I thought I detected in the book. You correctly stressed the huge difference in the amounts of natural vs. manmade toxins. But isn’t it also true that manmade toxins may be far more dangerous to us than the natural variety? Yes, the dose makes the poison. But some poisons are more potent than others. Yes, hormesis exists. But some toxins, including the manmade variety (and perhaps especially those?) may not produce a hormetic effect.

    I haven’t heard a reasonable objection on the site to the rationale for distilling one’s drinking/cooking water. It’s easy and inexpensive, and one can always subsequently add whatever minerals one thinks advisable.
    I’d appreciate any thoughts

  37. Hi Paul or anyone else,
    Can anyone explain or help me out with these symptoms please? I am 30 yrs old.
    Last week, I went to bed for the night and then I get uncontrolable bouts of shaking/tremors. This lasted for hours. I had no fever. I also felt very thirst with dry mouth and urinated frequently. This was a very scary experience. The next day I was exhausted and had a tight chest. The shakes came on he following night again but lasted less time. It’s not my blood sugar levels as those were tested and are fine.

    I seemed ok for the next few days and then I developed tight chest again all day long but I don’t think this is anxiety (despite doctors trying to convince me that!)

    They say all my blood results are fine except that I have elevated serum folate. Doctor was unable to give an explanation.

    Any ideas anyone? I am at loss as to what to do. Am waiting for an adrenal test result to come through just in case that is what it is. But why would I get so thirsty?


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

  39. hi Paul,
    on the off chance i catch with a ‘spare second’ 🙂
    i would be interested in your view/comments on the following 1991 study.
    here is the abstract;
    “The effect of dietary fiber on serum estrogen concentrations was studied in 62 premenopausal women. Their estimated daily dietary fiber intake was increased from an average of approximately 15 g to 30 g/d by supplementation with wheat, oat, or corn bran. This was done without any significant decrease in dietary fat consumption.
    After 2 mo on the high-fiber diets, the wheat-bran-supplemented group showed significant reductions in serum estrone (P less than 0.002) and estradiol (P less than 0.02) but no change in serum progesterone or sex-hormone-binding globulin concentrations.
    The serum estrogens were unaffected by dietary-fiber supplementation with oat or corn brans.”

    …any thoughts on what could be going on here.
    i know wheat bran is definitely not PHD. but find it intriguing that wheat bran specifically seems to reduce estrogen.


  40. Paul, do you know anything about milk butyrophilin, a protein in milk fat? I have discovered I have an allergy to it. Not sure if I need to give up all dairy including ghee and butter or not. I can’t find any information about it online. Do you know or could you point me in the right direction?
    Thank you

  41. How do I unsubscribe from your shop supplements and other mailings?
    thanks very much for all you do.

    • Look under the comment box (where you would fill in a new comment). There should be a link that says something like “manage my subscriptions”. There you can delete your subscription.

  42. Anthony Batchelor

    Hi paul im having a really hard time getting to the bottom of my gut issues that have been getting worse for about 4 years. Have had loose stools/diarrhea for months now in which time my weight has continuously dropped.Tried a ketogenic style diet for a month which did nothing to alleviate my symptoms and have had lots of tests with GI doctors to no avail. Bought your book and have been following the diet but nothing seems to stop the diarrhea, any suggestions? Thanks Anthony, UK

  43. Saturated fats lower insulin sensitivity?
    I have just found a web page that lists three studies that show that total fats in excess of 37% of calories, and saturated fats in particular, reduce insulin sensitivity. See the section “The effect of diet” on this web page:
    I am surprised and worried about this conclusion, as it goes against my high fat diet that I adopted after reading your book, Paul

    • It’s energy excess that causes insulin resistance. Higher fat intake is correlated with energy excess, but it isn’t the fundamental cause, and a high-fat diet that minimizes calorie intake promotes insulin sensitivity.

      • In addition to the three studies (24,25,26) in the above link, “Dietary Saturate/Unsaturate Ratio as a Determinant of Adiposity” here http://catalyticlongevity.org/prepub_archive/saturate-unsaturate-BMI.pdf suggests that the ratio of saturated to total fat reduces insulin sensitivity.
        I tend to agree with you Paul, that the energy excess causes insulin resistance, but it is surprising to see studies that show saturated fats are more culpable than monounsaturated and polyunsaturated fats.

    • Hi David, my wife and I have been following phd for two years + I was prediabetic A1C of 6.6 testing every 6 months came down to 6.1 then 5.6.
      My wife a insulin dependant type 2. Is using less insulin per day and has reduced her A1C from 7.8 to 6.0. I realize that her A1C is dependant on our ability to select the right insulin dose, but it is what it is and that is down.
      Hope this helps alfred

  44. Hi Paul,

    I was just wondering what you base your recommendation on placing carbs in the evening on? According to Dr Bill Lagakos, insulin sensitivity is highest in muscle in the morning, but higher in fat cells in the evening – and this should imply that carbs, fats, and calories early in the day are better for circadian rhythms and burning instead of storing of fats:

  45. Melatonin. I take 30 ml of tart cherry juice concentrate in a herbal tea two hours before bed. I find I sleep deeper. Do you think I’m getting enough melatonin or should I supplement??
    Thank you.

  46. Hi Paul,

    I drink Whey Powder put in 1 cup of Coconut Milk a day/few times a week, Coconut Milk is the best beverage I could find to put my Whey in.

    But 1 cup of Coconut Milk contains 550 calories and around 5 tablespoons of Coconut Oil. Do you think that’s too much to drink in one meal? Or since we can consume fats freely, that’s not a problem?

    Thank you,

  47. Quick question. I just started following your diet. I have been on it for two weeks now. All is going well. I have replaced my pasta with rice. Most of my rice dishes are calling for soy sauce. I am under the impression that soy isn’t the best chic for me when I am on this diet so do you have any suggestions for an alternative for soy sauce. Thanks


  48. You are really impressive with your quick responses. Its nice to know I can count on you for support. I saw the pesto recipe you posted but it calls for pine nuts. I thought we should stay away from nuts in general? if I am wrong could you recommend some safe nuts? I you to ear alot of almonds, could I reintroduce them back into my diet?

    • Hi Lucy,
      It’s a great diet isn’t it? Yes, PHD includes full fat dairy if tolerated. Many PHDers consume a fair amount too — butter, ghee, heavy cream, sour cream, creme fraiche, cheese, yogurt, sour cream, heavy cream, etc. Personally I buy organic and 100% pastured, or at least somewhat grass fed, if I can find it. Some people don’t do well on dairy; they say to always modify to your personal needs.

      Nuts and seeds are also allowed but aren’t recommend as a central component of the diet, rather, in moderation, like for a possible fat component of a snack or as a condiment or small component of a dish, such as pesto. Personally, I love almonds too, and I’ll often eat an ounce with berries and almond milk or yogurt for breakfast or as a snack. I try to buy mine organic and sprouted and I make my own my almond milk. I also eat 3-4 brazil nuts daily for selenium. Occasionally I top my dishes with macadamias, sprouted pumpkin seeds or hazelnuts too. The book outlines which nuts they favor over others. The main idea is that it is more like an optional food and shouldn’t displace the important 1:1:1:1 main components of the diet or the important supplemental foods like egg yolks.
      Get the book! There are great explanations about dairy and nuts in it!

  49. Ps. Are we suppose to have milk and heavy creams? I thought that was one of the foods we were suppose to avoid.

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