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)

Paul,

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,

A

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?

G

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.

Lupus

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

Depression


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 ?

10,169 Comments.

  1. Around 2 months after adopting PHD, I’ve started to experience acid reflux (which I’ve never had before). Especially given the delay, this could easily be a coincidence… But I thought it would be worth asking if anyone has any suggestions?

    I already ate PHD macronutrient ratios. So the main changes I made were replacing wheat with rice/potatoes/sweet potatoes, replacing walnuts with macadamias/cashews, replacing (most of) my chicken with beef/lamb, adding 1/4 lb liver to my diet once a week, and taking all the recommended supplements.

    • Are you eating egg yolks? Reflux is most commonly due to a deficiency of vitamins A or D or choline. I would also do intermittent fasting and drink black coffee during the fast.

      • What is the best alternative to egg yolks?
        I used to eat plenty but have just discovered I have a pronounced sensitivity to eggs (according to Cyrex Labs IgG/IgA test). From the test I can’t tell if it’s just the whites or both whites and yolk but I have been told to avoid both while I work on healing my gut.
        I’m thinking fish roe would be a good alternative, but I can’t eat it daily.
        I also came across this supplement: http://www.seekinghealth.com/optimal-pc-seeking-health.html
        What do you think? Is it better than just a basic choline supplement?
        Thanks

      • Thanks for your response!

        Yes, I’m eating 3 eggs (white and yolk) per day. Combined with the 1/4 pound of liver, is that enough for vitamin A and choline? Or would you suggest additional egg yolks and liver?

        I’m also supplementing vitamin D; after the reflux started, my 25-OHD level was measured at 49.

        I’m already doing intermittent fasting as you suggest. However, I tolerate caffeine very poorly… would decaffeinated coffee be a good idea?

        • i do not think that Paul is recommending that you drink coffee If you do not already drink it…? (i could be wrong. Paul?). unless it’s for the caffeine?

          i am presuming his meaning is that you do not add things (milk, cream etc) to any drinks during the fasting period.

          remember Paul’s American, i believe it is mandatory in the US to drink coffee 🙂

          • Ah. Alright, then I’ll continue my current intermittent fasting method of just water during the fast — unless Paul chimes in otherwise.

            (Uncommonly, just water would make me uncomfortably hungry; on such days, I eat some subset of coconut oil, spinach, cranberries, lemon juice, and vinegar.)

  2. Hi Paul, I was reading in the New York Times yesterday that they are discovering viruses in the body that have beneficial effects on health. What are your thoughts on intermittent fasting making the body inhospitable to pathogens and the possibility of reducing beneficial viruses (and other beneficial ‘critters’ like probiotics, bacteria, etc.)?

    • Daughter (17) has had severe health problems since treatment with antiobios, pain med, steroid then ulcer treatment for a nasty “virus” years ago. Suspect leaky gut and SIBO given her symptoms. Food intolerances just seem to get worse no matter how many things she eliminates. However after not eating 3-5 days due to mono sore throat and again months later after stomach flu – she improved drastically. This was before we connected her overall health to diet/gut health so both times she resumed western diet. Seems obvious to me that fasting killed off the bad guys until she refed/reactivated them. Would another fast followed by probiotics and PHD work? I know long term fasts are not recommended but chronic bad health seems the worse option. (seeing dr but no real help)

  3. I was wondering through my research and personal experience most disorders of the gut stem from infections originating from bacterial that then stem from a combination toxins and parasites feeding off each other and the body. After dealing with these issues and working with many diets to heal them nothing does the total job other than cleansing with natural products. You cannot heal something when the culprit is still thriving and sucking the nutrients from the body and/or not allowing the nutrients to be absorbed! I’ve been to drs and drs over the years to heal. It didn’t work. I ended up going to a naturopath and what do you know after doing a parasite/candida cleanse my symtoms have miraculously cleared! I consult herbalhealer.com take diatomaceous earth foodgrade and colloidal silver. I can now eat most everything I’ve had to cut out years ago and have no reactions. But , I chose, because after learning what helped me feel better when ill, to eat organic, grassfed foods to stay healthy and remineralize my body

  4. Hi everyone,
    So I have been on the diet for a month now. The first and second week I was seeing weight loss but the third and fourth week the scale is showing weight gain. I am wondering if its all the rice I am eating. Is there any other food substitution for rice that would be better for me so I can get back to my weight loss?
    Thanks for your help.

  5. Hi, I have also been told I’m intolerant to eggs… Is there any supplement those who can’t eat the egg yolks can take instead? Many thanks…

  6. Hi!
    Resently I´ve heard that to much eggs can have a negative sideeffect. Right now I eat 2 organic eggs a day. Im a bit confused on the critics and the nutrient rich egg. Am I to stop doing my morning routine of scrambled eggs? (:

  7. Dear Paul,
    I recently read about your concepts and the ketogenic ability eukaryotic fungus possess. I was on a ketogenic diet for about 3weeks combating the candida like symptoms, popping joint brain fog hair loss digestive issue. The symptoms were chronic and I had been on off paleolithic 2 years prior. I recently started introducing some white rice and sweet potatoes into my diet to coincide the biology you explain. I started experiencing piercing headaches and joint popping and clicking again. Is this die off from my immune system getting a boost or could it possibly be a bacterial infection I am dealing with. Also I am expiencing oral thrush after introducing carbs back into diet which I never had.

    Thanks much,
    Bryan

  8. Are the weights suggested to eat like rice and vegetables to be cooked or uncooked? I’ve always wondered about that. 🙂

  9. Paul, I have a question about yeast infection. I seem to do better on moderate carbs (1 cup of rice or potatoes or plantains) at every meal, together with pickled VGs, soup/meat, and avocados or some other fat, and green drink (basically greens, ginger, and lemon swirled in Vitamix). But lately, having added more fruit(and organic homemade popcorn), I have had yeast infection coming back and staying. I have been trying to eliminate fruit completely and reduce carbs, but my thyroid is not doing so well on low-carb and also I am suffering from almost non-stop infections and lesion inside my nose. They cultured it, and it is just “slight Staph”…Reading your blog about the importance of glucose in formation of mucus made me wonder, if I am not getting enough glucose…And yet, how do I do it without feeding this yeast? Any advice would be greatly appreciated. Natalya

    • Hi Natalya,

      Moderate carb should be best for yeast immunity as well as bacterial immunity. I would look to some other deficiency as the cause of the yeast infection; commonly low vitamin A or vitamin D are the major problems; eat liver weekly for A, plus green leafy vegetables and orange plants daily, and get sunshine or supplement D. Another possibility is low halogen intake — iodine and chlorine — supplement iodine 225 mcg/day and get adequate salt. A third is poor glutathione status; vitamin C and N-acetylcysteine can help there, plus zinc and copper in the right proportions.

      Best, Paul

      • Paul, thank you so much for a prompt response! And of course I have a couple of new questions back. I hope it is OK.

        I am already supplementing with vit D (last tested D25, was 49, so I supplement with 4,000 daily), so I will increase liver consumption and add NAC/vit C combo.

        Does 1 cup cooked plantain or rice or potatoes at each meal constitute “moderate?” Or, is it too “high?” And should I still avoid all fruit – for yeast starving? Also, last night I spent a long time reading around your blog on the topic of candida, and realized that my daily high consumption of coconut oil might have been the culprit too (I also have high HDL levels). Usually I eat 3-5 Tablespoons of coconut oil a day…so should I stop eating coconut oil until yeast abates, or is there a “safe doze” for me? And/or should I always eat it with starch from now on? Usually I whip it into my morning tea, drunk alone before breakfast

        On the other hand, if I am already on a good amounts of carbs, do you have any thoughts about the possible source of my non-stop nasal infections? My nose feels very dry, despite all the nasal lubricants I apply daily.

        Thank you again deeply for taking time to respond! Sincerely, Natalya

  10. I have a question about interpreting my lipid panel. Last year and again this year, my total cholesterol has been 196 mg/dl and now 189, so somewhat low. I agree with Paul’s posts that point to a total cholesterol of closer to 220 as probably ideal. My triglycerides are steady in the 40s, HDL is about 70, LDL around 110, and VLDL is 9.

    Let’s see if I can phrase my thoughts comprehensibly: Since my HDL is nice and high, VLDL is nice and low, and triglycerides are nice and low, does that mean my somewhat low total cholesterol is actually still great? It looks like the profile could only improve my total cholesterol in a healthy way by increasing LDL (directly or by solving some potential issue lowering LDL), but my LDL doesn’t seem too low, so does that imply that my total cholesterol isn’t actually unhealthfully low?

    • Hi Amelia,

      You have a terrific lipid panel that puts you at extremely low risk for heart disease. Your triglycerides and HDL are perfect and your LDL is in the optimal range of 110-150. Low VLDL is reflective of your low triglycerides.

      LDL is protective against infectious disease, but if your infectious disease risk is low then lower LDL may be beneficial (less inflammatory).

      Best, Paul

      • Excellent! That makes perfect sense and puts me at ease about low total cholesterol. I used to have levels as low as 140 years ago before my Celiac disease was recognized, but it looks like I’ve probably recovered from whatever was causing that.

        Thanks and Happy Advent!

  11. There’s an article in this week’s New Yorker on fecal transplants.

  12. Hi Paul,
    I’ve started doxy 100 mgs twice a day for severe dry eye syndrome, related to Sjogrens and lupus. I’ve been on this for 5 days and have worsening of symptoms. Do you think this is a sign I need to take it? I worry about long term antibiotic use but I’m tired of being chronically ill, and will do what it takes to get better. I’ve been trying unmodified potato starch, along with other sources of resistant starch to heal my gut, as I’ve been on a VLC diet for the past ten years with disasterous results.
    Also, is Uncle Bens rice a good choice for added resistant starch? or is it just too processed to be healthy?

    Thank you so much for taking time to answer our questions!!
    Sandy

  13. Paul,
    First off I wanted to say that I am a big fan of your book and think it takes a very common sense and scientific approach to nutrition and health. After a lab test a few months back during a routine physical, where my TSH was 4.82, my LDL was 197 mg/dL, my Triglycerides were 92 mg/dL and my Total Cholesterol/Hdl Ration was 5.2, my doctor wanted to put my on levothyroxin and a statin. I have a history of heart disease and high cholesterol in the family, so he was very concerned. I decided to see a Naturopath to get a second opinion, who thought I might have a fungal infection, so I went on a candida diet. In addition I adopted the Perfect Health Diet full bore, eating liver, egg yolks, coconut oil, bone broth in addition to the supplements and cutting out grains, beans, seed oils and sugar. Well, 6 weeks later, I returned to the doctor and had another blood draw, and to my surprise, TSH went up to 5.02, LDL soared to 239, my Total to Hdl went to 6.1 and my triglycerides went up to 109. Now even my naturopath wants me to go on a low fat diet to combat the cholesterol. She also prescribed Thyroxal for my thyroid (my T4 is 1.0 ng/dL and my T3 is 2.8 pg/mL) and non-flush niacin and advised I cut out the eggs and red meat to lower cholesterol. Now I don’t know what to do. Any ideas on why my biomarkers would have worsened on the diet? Given my family history, I don’t want be cavalier with the cholesterol and heart health, so any feedback would be appreciated.

    • Hi PDH,

      I may be in a similar situation as yours.. I eat a clean diet, PHD.
      My cholesterol ratio is almost identical..
      My naturopath has different ideas to yours.
      It could be your thyroid, if you can get your t3/rt3 tested it might show some low/high readings…
      Another potential issue I have is low HCl. We found this out from a urinary organic acids test. My body isn’t breaking down the food in my stomach and I’m having a few different symptoms (autoimmune/thyroid/cholesterol)..

      It’s a possibility… Urine test is quick n easy.

    • Hi PDH,

      First, your hypothyroidism should absolutely be treated with levothyroxine. Also supplement iodine per PHD advice, 225 mcg/day. Take levothyroxine to get TSH down to 2.0 or so, or lower if needed to relieve symptoms. That alone will bring your cholesterol down significantly. There are major health improvements to treating hypothyroidism so don’t shy away from this replacement hormone.

      The next step is to heal the gut – the high cholesterol and the hypothyroidism are both effects of endotoxemia, an excessive influx of bacterial cell wall components through a leaky gut. Adequate carbs, Liver, egg yolks, sunshine, green leafy vegetables, orange plants, vitamin C, bone/joint/tendon soups and stews, intermittent fasting with black coffee, circadian rhythm entrainment, diverse fiber, fermented vegetables, etc. This takes longer.

      It’s not unusual for TSH and triglycerides to fluctuate in that range. LDL went up because you went too low carb. Eat more carbs. Treat the hypothyroidism.

      Best, Paul

      • Paul, thanks for your response. I just picked up my levothyroxine prescription and will begin the hypothyroidism treatment with that. I will up my iodine intake from 150 mcg/day to 225. I have had some IBS-C type complaints in the past and think this too can be linked to my hypothyroidism. In fact, the IBS-C complaints are what first drew me to the PHD Diet and your site in the first place, before I discovered I was hypothyroid. Anyway, I will report back with my progress. Thanks again.

      • Thanks for your response. I just picked up my levothyroxine prescription and will begin the hypothyroidism treatment with that. I will up my iodine intake from 150 mcg/day to 225. I have had some IBS-C type complaints in the past and think this too can be linked to my hypothyroidism. In fact, the IBS-C complaints are what first drew me to the PHD Diet and your site in the first place, before I discovered I was hypothyroid. Anyway, I will report back with my progress. Thanks again.

    • do yourself a favor and hop on over to Dr. McDougals website.

  14. I have trying to find info for a friend of mine whose husband was in a wreck 4 months ago and has severe brain trauma. His eyes are open, and he can follow simple commands, but he can’t speak. He was moved out of a hospital about 2 weeks ago into a nursing home. He is around 30 years old. They have started speech therapy in the nursing home recently. He is fed Glucerna through a feeding tube. I was wondering if it might be helpful, if he was fed a ketogenic diet through the feeding tube? If so, is there anything pre-made that could be purchased? Or could a recipe be made that would be ketogenic, possible a recipe that is used for babies (Weston Price)? If you have any suggestions on sites we can search, that would be great! Thanks for any input you may have!

    • Hi Sandra,

      I don’t think a ketogenic diet is indicated; you want a nourishing diet to support wound healing. Collagen/glycine, vitamin C, silicon/seaweed, liver, egg yolks, vitamin D – those sorts of things. I haven’t looked at Glucerna but he would probably benefit from some supplements, starting bones/joints/tendons stock.

      Best, Paul

      • These are ingredient in Glucerna.
        Water, Corn Maltodextrin, Milk Protein Concentrate, Fructose, Glycerol, Short-Chain Fructooligosaccharides, Cocoa Powder (Processed with Alkali), Soy Protein Isolate, High Oleic Safflower Oil. Less than 2% of the Following: Canola Oil, Soy Oil, Cellulose Gel, Potassium Citrate, Magnesium Phosphate, Salt, Choline Chloride, Ascorbic Acid, Calcium Carbonate, Calcium Phosphate, Sodium Citrate, Cellulose Gum, Potassium Phosphate, Natural & Artificial Flavor, Potassium Chloride, Monoglycerides, Soy Lecithin, Liquid Sucralose, Potassium Hydroxide, Magnesium Chloride, Carrageenan, Turmeric Concentrate, Acesulfame Potassium, Ferrous Sulfate, Zinc Sulfate, dl-Alpha-Tocopheryl Acetate, Niacinamide, Manganese Sulfate, Calcium Pantothenate, FD&C Red #3, Cupric Sulfate, Vitamin A Palmitate, Folic Acid, Thiamine Chloride Hydrochloride, Riboflavin, Chromium Chloride, Pyridoxine Hydrochloride, Biotin, Sodium Molybdate, Potassium Iodide, Sodium Selenate, Phylloquinone, Cyanocobalamin, and Vitamin D3.

        This is not a health supplement by any means. Please, tell your friend to get her husband on the diet recommended by Paul. This formula could make a healthy person unwell!

      • Thanks so much for the info.

    • Your friend should look into HBOT treatments.

      http://www.hbot.com/

  15. I started on the levothyroxine and have had a few side effects such as elevated heart rate, muscle pains and some lightheadedness, but I assume this is my body adjusting to the dosage and will probably subside. I have read quite a bit from the “Stop the Thyroid Madness” about naturally desiccated thyroid (NDT) being preferable to levothyroxine because it provides all 5 thyroid hormones instead of simply T4. I was curious to see what other’s experiences were with levothyroxine, both good or bad or neutral, and Paul wanted to see if you had any opinion on the matter. Also, I will be tested for the Hashimoto’s as well in the next few days and wanted to see how that would change my diet/hypothyroid protocol if that was diagnosed.

    • Hi PDH,

      I find that people who take dessicated thyroid often overdose on T3 thyroid hormone. It’s easy to do. I think it’s better to start with levothyroxine and then test a small dose of a combination therapy. You want the minimal intervention and let your body do as much as it can. If it can convert T4 to T3 OK, then taking T4 only is best.

    • I have done extremely well on the Armour thyroid. Since my grandmother was treated with only levothyroxine, and it was badly controlled (she was always freezing cold, despite normal labs), I posited that our family might have some trouble converting T4 to T3 and asked to be put on the natural Armour thyroid to start. I’ve never looked back.

    • I had bad reactions to Levo, heart pounding and severe insomnia for example. It did not improve my TSH. I’m experimenting now with dessicated thyroid. I feel much better but my next lab work isn’t until next week.

  16. Regarding the use of vitamin C in cancer therapy, you may want to re-examine the evidence using high-dose IV vitamin C in the next edition of your book. Many of the studies showing no effect did not use high-dose and/or IV vitamin C, which acts as an oxidant at high-levels and may be helpful in some cancers. See the NCI summary at http://www.cancer.gov/cancertopics/pdq/cam/highdosevitaminc/patient/page2

  17. Have your thoughts on legumes changed over the years? My personal opinion is that so long as they don’t replace more nutritious foods they are harmless, and now we know more about resistant starch they may actually be more beneficial than previously thought. They aren’t bad for a number of nutrients and if soaked and cooked in a pressure cooker I believe “anti-nutrients” are reduced to insignificant amounts. Thoughts?

  18. This should be on the exercise/fitness equipment list
    http://bowproducts.com/

  19. What’d I tell ya.
    https://www.youtube.com/watch?v=H7aCSjC1xqs&list=PLbhWKPDKXIEAhNzG0GiCw7jE59KS6WH5w&index=10

    The more you flex it, the higher the resistance. Compact and easy to take with you. No impact on your surroundings, furniture, etc.
    http://bowproducts.com/

  20. Hi Paul,
    Do you have any advice on how best to reset circadian rhythm when dealing with jet lag? I have tried taking melatonin and GABA to promote sleep, neither help. Thanks.

  21. Hi Paul,
    I saw an earlier post, which you do not recommend a range for serum ferritin levels. Have you come up with a recommended range? Mine has been 160 a few days after donating blood. Thanks.

  22. Hi Paul, What do you think of psyllium husk powder for baking? Also what about arrowroot flour? Thank you,Sylvia

    • Hi Sylvia,

      They are both good and healthful. We tend to favor natural whole foods over flour or powdered supplements, but we don’t object to either, they look healthful in studies.

  23. Hi Paul,
    As I mentioned in another thread, I started the diet about a month ago, and it’s been really great. I have several questions, but before I bother you too much, I’d like to get a good handle on what I’m eating. Do you know of a good calorie counting program, that will total all the micro/macro nutrients I eat? I don’t have a smart phone, in case you’re thinking of an app.
    Thanks,
    Leo

    • A lot of people like Cron-o-meter, https://cronometer.com/, or MyFitnessPal.

      • Thanks. I’ve started a diary on Cronometer. I tried Myfitnesspal, but there are a few pretty important settings that can’t be customized on the web app. Although I thought I was following the diet pretty closely, and I’m shooting for 15/30/55%, I was shocked that yesterday I ate 24/42/34. I was also 300 cal below what I thought I needed to maintain my weight. Two questions:

        1) You’ve said not to count carbs from vegetables. What about from peas and green beans?

        2) I’m 155lb, 5ft 11in, 53 yo, sedentary most of the time, bicycle 3 times a week for 30 min hard, and do a brisk 1 hr walk on the other 4 days of the week. I want to maintain my weight. I’m using 2200 cal/day – does that sound reasonable?

    • Another one worth checking out is bitelog.com

      The site looks super clunky (especially the homepage), and unllike the other sites mentioned, I don’t believe it offers any kind of long-term tracking of what you eat.

      However, it’s pretty functional when it comes to quickly looking-up the macro- and micronutrient content of different foods. You can also add together the values of the foods you entered by clicking on “Show Totals”.

      Here’s a comparision between apples and oranges (100 g of each!):
      http://www.bitelog.com/mega-food-search.htm?q=orange&q0=100&f0=9003&u0=0&p=100&add_u0__f9200__q100=100+g

    • Another one worth checking out is bitelog.com

      The site looks super clunky (especially the homepage), and unllike the other sites mentioned, I don’t believe it offers any kind of long-term tracking of what you eat.

      However, it’s pretty functional when it comes to quickly looking-up the macro- and micronutrient content of different foods. You can also add together the values of the foods you entered by clicking on “Show Totals”.

      Here’s a comparison between apples and oranges (100 g of each!):
      http://www.bitelog.com/mega-food-search.htm?q=orange&q0=100&f0=9003&u0=0&p=100&add_u0__f9200__q100=100+g

  24. Hi Paul,
    I’ve been looking at my diet and I’ve found out that although I can keep omega 6 fats below the suggested max, and the total PUFA below the suggested max, I don’t see how I can meet the omega 3/omega 6 ratio. I think you said it should be 4/1. The best I could do is probably about 1/4, unless I switch to a mostly seafood diet. How important is the ratio if I’m below 5% total PUFA?

  25. Hi guys, I’m unable to practice daily IF because I work out in the morning and don’t feel well if I deprive myself of food for an additional 7 hours after the workout. Do you think it would be a decent compromise to fast for 23 hours 1x per week? Thanks in advance.

    • Wait — I’m confused — why would you have to wait an additional 7 hours?

      • Probably because Jon is working out very early in the morning, perhaps at 5 AM? If so, he may be talking about the 8 hr feeding window which starts at noon.

        • Gotcha! I do the same thing, but it’s pretty easy to pack a small high-fat snack to make it until lunch-time.

          • Hillary is exactly right. I work out at 5am and judging by how I feel when I attempt to continue the 16hr fast to approximately 1pm, I’m probably putting my body through too much stress.

            I know Paul doesn’t like fasts over 23 hrs so I’m wondering if a weekly 23 hour fast would make up for my lack of daily IF.

          • i agree Jon, not eating within an hour or so post workout is going to put your body under stress. & most likely destroy any hope you have on building/adding muscle (in fact you may lose muscle).

            are you able to move your 8 hr eating window forward, or would that disrupt ‘family time’ etc.

          • Yes, I think that would not be practical in the long-term. I’m starting to think a weekly 23-hour fast may be fairly ideal though. If autophagy kicks in within 12-14 hours of the fast I’ll have approximately 9hrs of solid autophagy.

  26. I apologize if this is already covered in the book, but how do I calculate the number of calories I should eat in a day?

    • Don’t. Do intermittent fasting and calibrate the amount of food so you are just beginning to get hungry at the start of the next day’s feeding window.

      • Unfortunately, that advice, along with “eat to taste” or “drink water to taste” is a little hard to nail down. Maybe I’m not as in tune with my body as others. So I guess I’ll go with trial and error.

  27. Hi Paul, I’m not entirely certain about this anymore, but I seem to recall you once mentioned that you were looking into a manufacturing a suitable ‘multimineral’ supplement for people following the PHD (based on the recommendations in your book and here on the web). Is something like that still in the pipeline?

    I was just perusing the kinds of trace mineral supplements that are available on the market today. There are some that almost seem satisfactory, except for the fact they all contain a-not-quite-insignificant amount of manganese. (Plus, of course, depending on the specifics of someone’s diet, other things like copper, zinc, and selenium may not be desired either.)

    Here are some examples anyhow:
    http://www.iherb.com/Thorne-Research-Pic-Mins-90-Veggie-Caps/18507#p=1
    http://www.iherb.com/Thorne-Research-Trace-Minerals-90-Veggie-Caps/18543#p=2
    http://www.iherb.com/Life-Extension-Only-Trace-Minerals-90-Veggie-Caps/39328#p=1

    I bet there would be a market for at least one product that contained just the most broadly applicable trace minerals. Something like a single capsule with Boron, Chromium, Molybdenum, Vanadium (and perhaps Silicon, too, if it made sense as a weekly supplement) would seem great and convenient to me.

  28. Dear Paul,

    Thank you for the work that you do

    I went on a strict Ketogenic diet for headaches from a concussion about a year ago. The headaches went away and I had tons of energy and motivation, but I would get these bouts of EXTREME anxiety and my ability to handle stress diminished. It wasn’t panic, it was a different kind of stress – maybe adrenaline? ANyways, I ignored it because other than the periods of anxiety, I felt really good, and like I said, no headaches). I was also sleeping extremely well for once (I am prone to insomnia). But as time progressed, these bouts of anxiety got worse, and eventually I had a horrible and unexpected nervous breakdown. I literally didn’t sleep for 3 days, and after that, I was severely depressed) I added carbs back too fast (I went from ketogenic to 40% carbs in a day) and that really messed me up too. I think my blod sugar sigaling was out of whack! I eventually found your diet, and balanced out. I’ve been following it for 4 months.

    But…despite my success, I still feel hypervigilant, and I still have a severley reduced ability to handle stress (compared to before I started the Ketogenic diet). I used to be so calm, but now I’m on edge much of the time, and I get disoriented and anxious when in the face of such small stressors (like a conversation, sitting in class, or driving a car). THe anxiety forces me to avoid things that I used to find enjoyable (fon instance, conversations, parties, driving. I also have a hard time eating often due to throat tightness and sensations of choking.

    Do you have any thoughts as to what might be going on?

    Thank you

  29. I have just finished reading the PHD as well as a few other books on nutrition, like the 10% solution by Ray Kurzweil. I am trying to make sense of the various information I am reading, and was wondering what your take was on the research he presents linking fat intake and heart disease and cancer. Are his data outdated or misinterpreted? As a reader, how to make sense of all the contradictory information available?

    Thank you for your help.

    • Hi Alex,

      Fat intake is generally harmful on an energy excess diet and benign on minimal-calorie diets. Junk food that lacks micronutrition leads to energy-excess diets. On energy-excess diets, fat (and saturated fat in particular) maximizes generation of reactive oxygen species with negative effects. This does not happen on more normal diets.

      It’s common for “high-fat diets” tested in mice to have 30-40% sugar, because it’s easier to get mice (and humans) to eat an energy-excess diet if you give them lots of sugar. So generally speaking, the negative effects of fat are strongest on high-sugar diets.

      In other contexts, such as PHD, saturated and monounsaturated fats are benign. Polyunsaturated fats in excess can cause problems even if the diet does not have an energy excess.

      Best, Paul

    • I share your confusion; especially when review Dr. Greger’s data on NutritionFacts.org. Paul’s points are well made; but I still have trouble reconciling the data on saturated fat and cholesterol intake and cardiovascular disease (CVD). I know fairly recent meta analyses have found little link between dietary fat and CVD; other than for PUFAs and transfats.

  30. Hi Paul
    I have a question about vitamin D toxicity/ supplementation. I’ve supplemented for years, and worked outdoors for decades on construction projects in sunny San Diego till retirement in 2010. Now I’m 64, in Washington, and taking 2500 IUs per day during the cloudy, inclement winters during which I’m mostly indoors. (I’ve planned to lower that to 1000 IUs during the sunny summers).

    BUT –
    Wanting to make sure I wasn’t deficient, I just had my 25OHD level checked….and, surprisingly, it’s 70.
    I’ve had kidney stones in the past,too, and I’m taking potassium citrate and magnesium citrate to prevent those from reoccurring.

    What do you think I should do about the high 25OHD? How soon/often to recheck?
    Thanks for any advice.

    • Paul, just a P.S.
      I had my genome run through Genetic Genie, and I have a VDR bsm ++ gene for vitamin D processing. According to this reference,
      http://resqua.com/702188759/what-info-is-available-about-vdr-bsm-gene
      that upregulates conversion of the 25OHD to the active form, which would tend to deplete the amount of 25OHD in the serum. Since I still have a level of 70 in the serum, this is kind of alarming.
      Thanks for any comment.

      • PPS
        CORRECTION and my apologies for the confusion, which I share.
        I have two genes associated with vitamin D processing, VDR Bsm, which is TT ++ status, and VDR Taq, which has GG — status. According to this:

        VDR Taq AA augments (increases) VDR gene expression according to a study, and protects against MS according to another study. This would seem to mesh with the view that Bsm TT/Taq GG is the riskier/slower version

        I convert 25OHD into the active form slower because of these genes, so that may explain my high serum levels of 25OHD. Not sure what to do about it though.
        Very confusing – thanks for listening.

        • PPPS
          This is a note just written to my doc, which I hope makes some sense of these posts.

          This level is high for people with normal processing for vitamin D, and is associated with kidney stones (which I’ve had) and heart disease. But confusingly, I also have a ‘slow’ version of the VDR Bsm gene (TT++) and that can impair the conversion of the 25OHD to the active, useful 1.25D form of vitamin D in the body.

          Could we test 1.25D and calcium levels to see what is going on?

          High levels of these are likely the proximate cause of kidney stone/heart disease, in people who metabolize D normally, so my own levels should help tell us whether I still need vitamin D supplementation because of my impaired gene, or whether I need to back off the supplementation because the gene isn’t having that much attenuating effect and I’m ending up with too high of 1.25D and calcium levels.

  31. I started taking levothyroxine a month ago for my hypothyroidism (TSH 5) and had hoped for some relief from IBS-C. But I have had little success. Gas/Bloating still an issue as well. I follow PHD, eat daily bone broth, weekly liver and supplement, but I was hoping to jump start the leaky gut healing and cure constipation. My naturopath recommended l-glutaminne and colostrum supplementation. Paul, any advice on these and any other recommendations to speed gut healing and cure constipation?Thanks so much.

  32. Paul, any thoughts on Denise Minger’s presentation at the 2014 AHS?
    https://www.youtube.com/watch?v=DLzn7mzfL_I

  33. Can your Cirdadian program be adapted for someone working a split shift?

    My partner and I are hoping to incorporate the Circadian plan into our lives. However it’s a challenge because he works a split shift—up at 3:30 a.m., finished at 7:00 p.m., with a midday break at home about 5 hrs long. Right now he sleeps about 5.5 hrs a night with a 1-2 hr nap in the afternoon, catching up as needed on the weekends. My work schedule is very flexible.

    Not sure how to proceed—-has anyone asked you this before? Thanks!

  34. Hi Paul,
    I have been struggling with an issue for months. I hope you could shed some light?
    After my miscarriage 3 months ago I developed UTI symptoms. Bladder irritation pre and after urination. The urine culture did not show anything wrong. I was put on Trimethoprim antibiotic for 5 days which did help but 2 days later symptoms returned. Since then my bladder symptoms return about 3 times per month for about 2 days in duration along with tight and heavy chest symptoms or around the ribs. This is the most uncomfortable symptom. I have been following a natural protocol of probiotics and oil of oregano for almost 2 months after discovering I have medium overgrowth of Klebsiella Oxytoca and Hefnia Alvei and mild overgrowth of candida (results from metametrix stool test 2 weeks after my antibiotics).
    I have also noticed I get ‘heat’coming up into my mouth from my breath. I think this coincides when I eat more sweet things like honey or dates. So I am stopping those extras for now.

    • You could try d-Mannose (1 tsp 2-3 times/day – works like cranberry juice only better). And/ Or the over the counter product Diflucan 150 mg 1 capsule 3 days in a row along with Uristatin [by Thorne]x4 / day for a month. This helped my chronic UTI symptoms when antibiotics didn’t work or didn’t work for long. And of coure, no sugar, grains, etc.

      • Thanks. d-Mannose never worked for me. Tried it a few times. It apparently only works for e coli infections. I’m just not sure if what is going on in me is indeed a UTI or something similar. I don’t understand why I get a tight chest and strange sensations around my ribs when the bladder symptoms come on.
        Any ideas what tests I could do to help me find out?

        • Once the MDs were through with me, I saw a Naturopath who did a variety of tests the names of which I don’t recall – which led to the trial of Diflucan and Uristatin (which also fixed chronic athlete’s foot).

          • I have seen a naturopathic practitioner and that’s how I found out about my gut infections. I was also put on probiotics and oil of oregano. But 2 months later and I still get symptoms, it usually starts with tight chest and then usually the bladder irritaion starts. I try upping my dose of Vit C and raw garlic ad it tends to clear. the problem is I’ve lost almost 5kg in weight orver this time! I’m eating fats, carbs, nutritious PHD type food. I’m now thinking if I should lower my starch intake as it may be feeding the bacteria more than me!
            Also,I can’t understand why when I do a dipstick test or doctor’s urine culture nothing wrong shows up. I’m thinking my protocol I’ve been put on is not enough.

    • Hi Claire, it does sound like you’re struggling with something more than just a UTI, and if you feel that you want to try something else than Naturopathy, I can recommend seeing a doctor of functional medicine. The reason for my writing though is that I though I’d recommend a few herbs that have helped me with recurrent UTI symptoms. Like you nothing shows up with the dip test, but antibiotics help for a short while, but then symptoms return. Recently I’ve managed to stay off the antibiotics by taking Uva Ursi, Ecchinacea, Marshmallow Root, Cornsilk Stimga and Buchu Leaf in a large glass of water every time I get symptoms and this seems to clear them. If you google healing herbs for interstitial cystitis or just cystitis you might find other alternatives also. The important thing is to find a quality herbs, and perhaps to use them on a daily basis until your symptoms are under control.
      Angela Kilmartin has written about cystitis and candida and I can recommend having a read as it might help you shed some light on your situation. I find her writing style irritating, but she also has some good tips that have helped me reduce my frequency of infection. I hope this clears up for you!

      • The Thorne product, Uristatin, contains some of those herbs: Buchu extract (leaf) (Agathosma betulina) 300 mg.
        Echinacea angustifolia (root) 300 mg.
        Berberine HCl (from Indian Barberry extract) (root) (Berberis aristata) 300 mg. Uva-ursi extract (leaf) (Arctostaphylos uva-ursi) 300 mg.

    • Hi Claire,
      Within Chinese Medicine, heat in the small intestine can cause symptoms like burning during urination, scanty urine, etc, that can be mistaken for a UTI. Because the small intestine channel is paired with the heart channel, there can also be symptoms experienced in the chest area.
      It might be worthwhile to see an acupuncturist or chinese herb specialist, as they can look beyond the bladder for this.

      • Thanks for all your tips. I don’t seem to get burning or any pain during urination. My urine looks clear. The irritation seems to be either if my bladder is full or after emptying it seems irritated/sore. But not burning.
        I just am surprised why this all started after I cleaned up my diet over the last few years. 2 months ago I removed 3 foods I am sensitive to based on IgG/IgA blood test. I had a miscarriage 5 months ago and the bladder symptoms started a week later. I never experienced bladder problems before. It’s been going on for a few months now.

        I’m wondering if an organic acids urine test would be useful.

  35. Dear Paul,

    I am in the process of reading your book – thank you so much for your amazing work – and would like to ask you about my daughter. She has had a rash more or less since she was born. Sometimes it’s better, until it flares up again. Last year, at 3 years of age, she suddenly developed severe pollen allergy. Especially her eyes reacted severely. Despite medication, the symptoms have continued for half a year now. The medication alleviates them, but does not remove them. Allergy testing revealed an allergy to hazelnuts, peanuts and soy. Last week she was accidentally given a small amount of hazelnut containing musli at day care and her lip got very swollen and is still abnormal. She also got quite a rash. She has not had these kind of reactions before, so I feel the allergy is escalating at great speed. She often complains about abdominal pain and has had some difficulties with bowel movement. Of course it is difficult to know exactly what is going on with a 3 year old, especially as her speech development has been a little delayed (another symptom, I would say). She was recently tested for celiac disease, but the result was luckily negative. She started daycare this autumn and has most of her meals there. I know they eat a lot of grain and suspect this has something to do with the worsening of the allergies. It is, however, difficult to test how she would feel without grains, as the daycare demands a doctor’s perscription and the main stream doctors in my country would just say that since there is no celiac disease, there’s no need to avoid grains. She was born by means of c-section due to breach position and sometimes I wonder whether this has affected her bacterial flora in the gut. Could she also be deficient in some substance? Do you have any suggestions? I will, of course, try to get that perscription, so we can see what happens if grains are eliminated form her diet.

  36. Hi Paul,
    What is your take on iodized salt? Is it effective, and if so how much is needed to satisfy the daily requirement of iodine?
    Thanks,
    Leo

  37. I have been colonized with mold and in breaking it down with antifungals I have seemingly released a virus. In concert with this I am experiencing connective tissue symptoms that are relieved by choline supplementation. Is it possible that a virus is stealing the choline?

  38. Hi, Dr. Jaminet,

    My wife and I are doing very well with the PHD lifestyle and diet. We have incorporated what you have suggested (food, supplements, IF, circadian rhythms, stress management, broth, proper starch prep, etc.) and feel fantastic. The only lingering problem is my wife’s hyperglycemia (fasting and post-prandial), which I have often wondered was related to her desiccated thyroid treatment. (As an example, my fasting blood glucose this morning was 91; hers was 130.)

    We have been reading the Q&A section and find it very informative. I was wondering if you could expound on a comment you made to “PDH” on December 9th, 2014. You mentioned it being easy to overdose on T3. Is this something that is discovered on labs, symptoms, or both? All my wife’s thyroid numbers are incredibly low (and TSH is essentially 0), but I cannot help but think the prescription is effecting her glucose in some way. She says she will simply stop testing her glucose as she doesn’t feel horrible. I think this is not a wise decision. Thanks for all your hard work.

    • Hi Bernard,

      Normally, it is not a good idea to take so much thyroid hormone that TSH goes to zero. Normally, a fasting blood glucose of 130 indicates diabetes, not a mis-dose of thyroid hormone.

      Is your wife under a doctor’s care? It would be good to have professional analysis and guidance of her situation.

      Best, Paul

      • Thank you for your response! Yes, she has been with her Endo for several years. He doesn’t know what is going on with her blood sugars, but states she isn’t a diabetic. (Her last A1C was 5.3 if that means anything.) I think it’s time for a physician change, but what do I know? Thank you again for your time. I just don’t want to see her bury her head in the sand and give up.

        • Hi Bernard,

          I’m going to guess she is too low carb, that would explain low TSH with low T3/T4 and also high fasting blood glucose (due to adrenal stress hormones).

          Try to get her to eat more carbs.

  39. Hi Paul,

    In terms of gut healing.

    I am just wondering what you think about probiotics, are they necessary? A already eat fermented veg and milk products and have bone broth when possible.

    I am thinking about adding a soil based probiotic as well (prescript assist, aor probiotic 3), do you think that they are safe? I have seen some people question the spores used in them.

    I also take betaine hcl with some meals and it seems to help.

    Thanks,
    Gareth

    • I would also appreciate your opinion about soil based probiotics. I have been put on Prescript Assist, after discovering (from 2 stool tests) that I have no growth of Lactobacillus bacteria (despite eating fermented foods (kefir, yoghurt, sauerkraut) daily for a 3 years + and also overgrowth of pathogenic Klebsiella & Hafnia. Now that I have discovered I have a sensitivity to dairy I am not eating as many fermented foods (only a bit of sauerkraut with lunch or dinner). I hope capsule probiotics are not too bad?

  40. Dear Paul,

    Thanks so much for all the good work you do. I was hoping if you could shine some light on a health issue of mine. I have recently found out that I have a gene that makes T4 to T3 conversion difficult/impossible. As far as I understand my labs my TSH is practically 0, my T4 is ok, but T3 is low. I’m currently taking 100mcg/day of T4 and 12.5mcg of T3.

    My functional medicine doctor has said he can’t increase my meds until my low HDL increases (48 mg/dl). I’m feeling very tired at the moment, but I’m wondering if this has to do with my adrenals. My cortisol is a little low, especially from the 24h urine analysis where the tetrahydrocortisol was 0.82 mg/24h. I guess my actual question is: should I fast in the morning? I read that you should eat breakfast if your adrenals are a bit weak. I’m currently taking both pregnonelone and DHEA, but will soon change to pregnonelone alone at an increased dose.

    Many thanks again for all that you do!

    M

    • Hi M,

      I have to say what you are doing sounds very risky to me. I’ve heard of polymorphisms in the deiodinase gene for converting T4 to T3 but never of a mutation that makes it impossible.

      The main cause of adrenal stress is overdosing on thyroid hormone. TSH of 0 suggests that is what you are doing.

      The most likely cause of low T3 is undereating (calories or carbs).

      Fasting – eat if you are hungry, get sources of electrolytes while you are fasting (salt and vegetables with potassium, e.g. tomatoes).

      • Hi Paul,

        Thanks for your reply! Apologies for the way I put that. I’m talking about the Heterozygous genotype thr/ala, which makes the conversion slower and less efficient, not impossible.

        I guess the problem for me is that I’m very low in energy and my T3 are still on the low end, especially in the 24h urine sample (1030 pmol/24h reference 800-2500) whilst T4 is comfortably midrange (1640 pmol/24h ref. 550-3160) My T4 levels have even decreased a tiny bit since I introduced T3 in my regime. Can I still be overdosing?

        On the adrenal front everything aside from allo-tetrahydrocortisol, which has increased, and DHEA which has stayed the same on medication, all the markers, pregnonelone, tertrahydrocortisol &cortisone, and total 17-OH-steroids have gone down). So I guess what you’re saying makes sense, but I’m not sure why I should be so tired. Only tetrahydrocortisol was below range and the others “normal”.

        As for undereating, I’m not sure, I haven’t followed PHD guidelines as well as I could the last couple of months but before then I was quite good for nearly a year, and T3 was even lower at this point. (400 pmol/24h). And I’m chubby, so I’m scared to increase my food!

        Thanks for the fasting advice!

        All the best and many thanks!

  41. Hi Paul!
    I read your PHD book and I found it very interesting.
    I’m 32 years old and I have vitiligo, this make me feel really frustrated. So I would like to know if you recommend your diet for the treatment of this disease? Because I have also read about others postures.

    Thank you

    • Hi Priscilla,

      Yes, I do. Vitiligo is somewhat mysterious but PHD has done quite well with autoimmune conditions generally. Gut bacteria are often an issue and PHD is excellent for the microbiome; also PHD tends to normalize immune function through nutrition.

  42. Cacao Mousse
    Pour a one liter box of AROY-D coconut cream in blender. Add 3 tablespoons, or to taste, raw cacao powder and blend, then put in fridge to chill.

  43. Hi Paul,
    Is taking a Desiccated Liver Supplement ok for those who can’t/cook eat liver. This one looks good – but I am not sure. http://www.perfect-supplements.com/Perfect-DesiccatedLiver.html (It seems that if one took 5-6 capsules a week they would get ~ 1/4 pound – and it’s grassfed). Thanks Paul for all your amazing work!

  44. Hi Paul,

    David Asprey, Larry WIlson, M. D., and others are beginning to recommend against drinking organic kombucha. Are there really dangers? They write about aldehydes and uncontrolled bacteria being negative for the body. I have had as much as 1-2 glass bottles in one day, especially when detoxing aluminum, which causes burning in the brain while detoxing it, as you may know. I use only the organic ginger kombucha, none of the soda-pop sweet varieties. I would really appreciate your opinion on this, as other fermented foods like cheese, yogurt or sauerkraut do not satisfy me instantly like the kombucha does. I have other sick clients who like to sip it who would also appreciate your thoughts on this.

    Thank you so much,

    Van
    http://www.vhHealth.com

    • My experience drinking kombucha resulted in a hideous years long yeast infection that nothing could seem to touch. ONLY AFTER I REALIZED THAT IT WAS POSSIBLY KOMBUCHA, and cut it out of my diet, AND took a LONG course of Diflucan (Fluconazole) did the infection finally go away. I am still prone to yeast infections if I need to take antibiotics. Researching the product after I realized that kombucha was what was causing the issue, I found that MANY other woman had experienced the same results. I wouldn’t touch it again if you paid me.

      • Thank you, MU Lee, for this comment. I have quit it for a week now, but still crave it when I am eating cooked food. It could just be that my adrenals are burned out (they are), and the kombucha is almost like an instant “hit” of energy. I am going to stay off of it, but till would highly value others commenting on their experience with kombucha. I have been dumping a lot of copper and aluminum on the Nutritional Balancing program, which I have made pretty much into strict PHD plus the NB supplementation based on my labs…making a lot of progress! Best wishes, Van

    • Hi Van,

      I would be concerned about yeast if you have an active fungal infection. Otherwise I would not be too concerned about kombucha. If you like it it is more likely to be good for you than harmful.

  45. What is considered a high TRI/HDL ratio?

    In your book you advise that a good proxy for determining LDL type is the Triglyceride HDL ratio. When the ratio is high LDL particles are mostly small/dense. My Tri’s are 25; HDL 119; LDL 124. My TRI/HDL ratio is .210 – but I don’t know what that means.

    • Wow, Kim – your profile sure doesn’t sound atherogenic. Your Triglycerides are very low and your HDL is very high. Seems ideal, so I’m anxious to see what Paul says as to whether he has any other concerns with your numbers.

    • Hi Kim,

      Well, you are in a range where there is not a lot of data to help us. But it is extremely low for CVD risk. Your LDL is perfect, any HDL above 70 is good for CVD, and low trigs are also good for CVD and mean you don’t have metabolic syndrome.

      However, very high HDLs may accompany an inflammatory process or could indicate you are overeating fat; and the meaning of very low trigs is unclear. You might try eating slightly more carbs and slightly less fat as a tweak.

      • Paul – here is the kicker. My alkaline Phosphatase has been elevated for many years: The first time it was taken: 2009: 153; 2011: 188; later same year 260; 2012: 186; 2013: 211. No one has been able to figure it out. Will start to eat less fat and more good carbs. So you mean veggies or starchy carbs? Also if you have any idea about my alkaline phase let me know. I live in Massachusetts, on the south shore.

  46. Here’s an idea for an improvement to the french press. A magnetic stirrer vane device is placed in the bottom of the carafe below the lowest level of the filter screen. The vane device is laterally spring loaded so as not to fall out during dumping of grounds or rinsing but easily removable for thorough cleaning. A magnetic actuator below the carafe would be part of the plastic base of the press and be operated by a knob on its side.
    The device would be simple, foolproof, not unattractive, durable, and easy to produce. It would eliminate the need for opening the press during brewing, save an extra utensil and be less messy, decrease brewing time, save coffee/tea, and be pleasant to operate.

  47. Hi Paul,
    Are you familiar with tests that can measure total cholesterol? I had a test where the Total Cholesterol = 192, but if I add up the LDL-C, HDL, and Trg/5 (Friedenwald), I get 206. Thanks.

    • Total cholesterol is accurate. LDL may have been calculated not measured. If it was calculated they didn’t use the Friedewald equation; if it was measured it is more accurate than the Friedewald equation. Triglycerides don’t need to be accompanied by cholesterol so that equation is an approximation only.

      • Thanks for the clarification Paul. TC=192, LDL-C Direct = 136 (>130 flagged as high), HDL-C = 51 and Trgs = 95. LDL-P =1741 (>1360 flagged as high), Apo B =97 (>80 flagged as high)
        I don’t know if that LDL-C is calculated or measured.
        Is LDL-P the measure of the small dense particles compared to the large fluffy LDL, and what is your opinion on high levels of LDL-P and CHD risk? Thanks.

        • Hi David,

          Your LDL is perfectly normal, ignore their reference ranges, which are biased toward low LDL. Your numbers generally are quite good, but I would like to see HDL higher (toward 70) and triglycerides lower (toward 50). But your HDL and triglycerides are both near to or better than the population average.

          Your levels of LDL-P are about what evolution selected as optimal for human beings in our ancestral environment. In today’s environment they may be a risk factor for heart disease if you are eating junk food, not exercising, etc. If you are eating PHD and living well I wouldn’t worry about it.

          • Thanks Paul. My triglycerides have been in the 50-60 range before. My HDL has never tested out of the 50-55 range, I have tried the ways you recommend- exercise, red wine, coconut oil, etc. Do you have any other recommendations at this time?

        • To raise HDL, raise the fat portion of your diet a bit.

  48. Hi Paul, what is your recommendation regarding testosterone levels?

    Is the optimum to have between 700-800 levels for males in their 30s? Or is free testosterone more important?

    Do you recommend Tribulus or any other supplements?

    Is it safer to take it with aromatase inhibitor and DHT?

    • I don’t have a recommendation regarding testosterone. There isn’t enough research on it, particularly in people on low-carb/Paleo/PHD diets.

      I don’t recommend taking Tribulus or other pharmacological herbs as supplements. I recommend taking herbs as spices on food, that way your sense of taste and smell will help you avoid overdosing.

      PHD will raise testosterone naturally so there is no need for supplements.

      • Paul, I thought TRT was studied from 70s. So besides not enough data, what are the main dangers? Screwing up hormonal system?

  49. Dear Paul,

    I would have a few questions regarding legumes, nuts and seeds.

    Legumes are not recommended due to their toxicity. However, you mentioned that you eat peas and green beans. How are they different from other legumes? Dr Perlmutter writes in his book that chick peas are also an exception. Would you agree or would you avoid chick peas? Peanuts are of course not recommended, but what is the case with soy? I understood from your book that soy is better avoided, but there were some recipies in the book that contained soy sauce. Is this a case of the dose makes the poison or is soy safe in certain forms?

    You write that seeds can often be toxic, as it is the plant’s way to protect itself, but that most tree nuts are safe to eat. I’m not too familiar with how different nuts grow, so I would like to check whether the following nuts are safe to consume: almonds, pecans, macadamias, hazelnuts, Brazil-nuts, walnuts, pistachios and cashews (those are basically all the nuts I could come up with :0) )? What would be a suitable amount and frequency for nut consumption?

    Then how about seeds? Many would claim that both nuts and seeds are “packed with nutrients and good fats” and should therefore be included in a healthy diet. However, we know that omega-6 rich vegetable oils are to be avoided. Does this imply that also seeds (sesame, chia, sunflower, hemp, pumpkin, linen) should be avoided or are they healthy to eat as seeds in a natural, unprocessed state? It’s said that it is good to soak seeds overnight in order to remove possible toxins (so apparently they do contain some toxins) and to make them more easy to digest. Would you include any seeds in your diet? Some recipies in the book seemed to contain e.g. sesame oil. Is that a low omega-6 and low toxin oil or is it another example of the dose makes the poison? At the moment I am only using olive oil, coconut oil and butter. I do, however, have very dry skin. Might it be a good idea to increase the intake of some type of fat and in that case, what type of fat is most beneficial for the skin?

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