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. thanks paul, am i correct in assuming then that the rest of the body’s daily caloric needs are supplied from fat stores? since your keto-prescription above accounts for maybe 1,000 calories? (i dont know how many cals 4 tbs mct oil is but i just assumed 400)
    is there a ketogenic daily calorie range for people who are more active? i.e. can you still be in healthy ketosis eating 1800 cals a day in the same ratios?

    as for protein (100grams, 400 cals, at least 5 grams of which being leucine) does it matter what kind? i’m assuming protein higher in bcaas, or protein from gelatin would be better i.e. more ketogenic and anti-inflammatory.

    Hi Darius,

    No, there’s no caloric deficit. Make up the rest of calorie needs from fat.

    Choose sources to give a nourishing diet. Liver, shellfish, bone broth, vegetables … nourishing foods.

  2. thanks again paul
    and as an aside, apart from ray peat believing that lots of fructose has beneficial effects, your PHD diet and his dietary ideas are actually very similar and complimentary from my initial research.

  3. Hello Paul

    I believe I have a bacterial infection and a fungal infection.

    About 5 years ago, due to eating too much McDonalds during high school I developed an undiagnosed gut problem (diarrhea and vomiting when ate glutein or casein(milk) – was never diagnosed but probably celiac) For about 6 months i ate mostly pasta and beans with occasional yogurt. For some reason pasta didn’t induce vomiting/diarrhea but bread/pizza/etc did. So after about 6 months I found that I could eat bread now without getting diarrhea so I started eating regularly again. The standard american diet – processed meat, pizza, bread, supermarket milk, processed junk etc. About 4 years ago I started developing a rash below my bottom lip which was later diagnosed as seborheic dermatitis. It got worse and worse and eventually I couldn’t ignore it anymore (doc said no cure). And thats when I started searching online for cures/treatments – which was about a year ago (I was still eating SAD). About a year ago I found GAPS and followed that for a few months with good results (compared to SAD diet) and my symptoms improved. My seborrheic dermatitis got a little better and my brain was more alert among many other symptoms.

    Then I found the PerfectHealthDiet (about 2 months ago). Got the book, finished it. So basically i started doing GAPS + starches (potato/rice). I did this for two-three weeks and I just noticed today that my brain is not as alert as when I was doing Gaps (lower carb); so I have a bacterial infection right?

    As for the fungal infection i think its pretty obvious given that I have seborrheic dermatitis + minor toenail fungus on two toes.

    Given those two conditions I would also say I have leaky gut?

    So what i wanted to ask you is how do I balance my carb intake for fungal vs bacterial? Which one should I tackle first? When to start taking anti-fungals?
    Other symptoms: cold hands and cold feet, constipation, some food sensitivities but not too severe. And what else would you recommend I do?

    Current diet: bone broth + vegetables everyday with coconut oil, liver regularly, salmon, organic chicken wings + thighs, some lamb and some veal. Carrot + beet juice in the mornings. Ginger tea occasionally. Rice + potatoes. Multivitamin, selenium, K2, 300mcg iodine, fermented CLO 1 tsp/day, probiotic capsule, epsom salt bath.

    Thanks Paul for doing this q&a. Once I heal I am going to recommend the book to family and relatives – people don’t believe you until they see results.

  4. Thank you so much for taking the time to answer my question on Food Combining. I am clear now and free. That did it. Slowing down digestion as a good thing makes perfect sense to me.

    One more request. Any news about a recipe book coming out any time soon. I do enjoy the recipes posted here, but it sure would be wonderful to have another book by you–a recipe book with meal plans would be a God-sent to me.


    Hi Isabel,

    We are planning a cookbook, it should come out in the second half of next year.

    Best, Paul

  5. Thank you very much for answering my question Paul. Very kind of you to take the time to answer questions in this Q&A section.

  6. I purchased and read your book and have started implementing as much as I can but I have two questions;
    1) Is my blood sugar to be below 140,even after just eating or is that 2-3 hours after eating?
    2) What about eating real sourdough white bread? I have heard that the fermentation changes something and many people are able to tolerate it that cannot eat white bread or any wheat for that matter.


    Hi Suzy,

    It’s good for blood sugar to be below 140 mg/dl at all times, but I wouldn’t be too concerned about slight postprandial elevations. That may suggest that you need to eat carbs more regularly, or that you should combine the carbs with more fat, vegetables, vinegar.

    Sourdough bread is better than non-fermented bread, but fermentation doesn’t eliminate wheat toxins entirely so I would still recommend avoiding wheat and eating rice, potatoes, or other safe starches instead.

    Best, Paul

  7. Hi Paul,

    I pretty much exclusively eat locally grown white potatoes for my daily safe starch consumption. Are glycoalkaloids a concern? Do you feel it is necessary to peel potatoes to reduce glycoalkaloids consumption? I enjoy the peels on the potatoes, but have been peeling them to avoid the majority of the glycoalkaloids. Thank you!


    Hi Nick,

    Potatoes should be kept in cool, dark, dry conditions post-harvest. If the skin is broken or they are exposed to light, moisture, or heat, then glycoalkaloid toxins will be produced, especially near the skin.

    If commercial varieties of potatoes are properly handled then I don’t think it’s necessary to peel them. However, if they’ve seen light etc., then peeling is a sensible precaution. If you see any green areas, discard the potato.

    Best, Paul

  8. Could you advise what level of copper is recommended for women, and how best to test copper levels? I have read about copper toxicity being an issue. Thanks.

    Hi Molly,

    In general 2-4 mg/day from all sources is a good intake level of copper, assuming healthy zinc intake. Too much copper is a risk factor for cancer, too little for cardiovascular disease. Copper toxicity is an issue, most commonly this occurs with copper pipes or pots but can also occur by supplementing or eating a lot of copper-rich foods like beef liver. However, deficiency is much more common than excess.

    There are tests for serum copper and ceruloplasmin, a transporter molecule which is made of copper. If you get the tests refer to the lab reference values for normal ranges.

    Best, Paul

  9. Hi Paul —

    In your book, great book BTW, you mention you sometimes eat two or three eggs a day, if memory serves. How does this affect your blood cholesterol readings? You may have answered this question previously but i searched your site and couldn’t find the answer. I recall reading somewhere that dietary cholesterol has no correlation to blood cholesterol so perhaps that’s the answer but I’d appreciate it if you could expand on this issue a little.

    Another question. You recommend coconut oil. Is there any difference between coconut oil and coconut butter. (I asked this two months or so ago but must have missed your reply.

    Finaly, WOW, I can’t believe you take the time and have the patience to reply to everyone in need. Enormous contribution to the health and well-being of the world!


    Hi TC,

    I do try to eat 3 egg yolks a day. It has no effect on blood cholesterol, unless you had a lipid deficiency in which case it would improve it.

    Coconut butter has more coconut meat than coconut oil and therefore has a stronger coconut flavor. But nutritionally they are very similar.

    Best, Paul

  10. Hi Paul.

    Just wondering if you have any specific nutrition/supplementation tips for dealing with urgency of bowel movements. It causes me great anxiety and i’d love to be able have more control in that area.

    p.s. tried rice – no dice! I’m a bowel disease sufferer so not that suprised. Going for the rice syrup next.

    Thanks, Mike

  11. Greetings and happy holidays!

    Since June of 2010 I have been eating a low-carb dietary system and exercising once a week with high-intensity workouts with seven days rest in between. From June 2008 until February of this year I went from 208 pounds to 190 pounds. Since February of this year I have maintained my weight between 185 pounds to 190 pounds. I’m 6’2″.  I think I may be eating a very low carbohydrate dietary system. I’ve read this may not be beneficial in the long run. I am thinking of increasing my carbohydrate intake. I don’t feel bad or anything; I actually feel the best I’ve ever felt in  my whole life. Most of my carbohydrates come from vegetables not including root vegetables, except for carrots. Sometimes I will have a little bit of sweet potato. I usually avoid rice, sweet potatoes and potatoes with the meal because I eat meat most of the time and if I mix rice, potato or a sweet potato with meat at mealtime, my digestion becomes sluggish and I experience fatigue and brain fog. Not including carrots. I do fine with that root veggie. I like rice, sweet potatoes and potatoes, and I’m considering adding them back to my meals but I don’t want to experience the sluggish digestion. Is it okay to eat a sweet potato or a potato by themselves if I add butter to them? I seem to recall reading that eating carbohydrates by themselves is not good for you.

    Thank you for your time!

  12. Hi Paul,

    I was wondering if you’ve ever seen this Vitamin D Wiki (homemade Vitamin D light using a reptile UVA/UVB light bulb) and what you think of it: http://www.vitamindwiki.com/tiki-index.php?page_id=982.

    The Vitamin D lights and tanning beds that Dr. Mercola and others sell are quite expensive (no less than $400), so this homemade version appeals to me. I try to get a healthy dose (20 mins at noon) of sun when the weather is good here in Portland (Oregon), but since that’s fairly limited, I’m intrigued by this light idea and it’s potential benefits over supplementation with synthetic D. Do you think basking under a full spectrum UVA/UVB light is a safe option?

    Your thoughts are appreciated,


    Hi Jess,

    You know, I’m tempted to try this myself. I think a 13 watt terrarium lamp should be pretty safe.

    Best, Paul

  13. Hi Paul,

    I was wondering if you knew of any makeshift(or possibly just less harmful longer term) antibiotic therapies from natural sources (I.e. Oil of oregano,etc)
    Thank you for any suggestions

    Hi Drew,

    Most plants, but especially traditional herbs, do have antibiotic properties. However, these will mostly be effective in the gut, especially the small intestine, not as systemic antibiotics. So more effective for SIBO than for systemic infection.

    Oil of oregano is a good one, or oregano itself.

    Best, Paul

  14. Hi Paul,

    I was looking through the reader results and noticed someone mentioned a goldilocks zone for fiber intake. I realize the information may actually be in your book, but I am waiting for the ebook version, so I was wondering if you could give me some idea as to the amount and the reasoning behind it.

    Thank you

    Hi Catherine,

    The idea is that when you eat too little fiber, you have too few gut bacteria, as when you take antibiotics, and this causes the immune system to relax and makes pathogen entry more likely; whereas if you eat too much fiber, you have too many gut bacteria, the immune system works to control the bacterial population, and you have unnecessary inflammation and immune activity.

    We think the best fiber intake is probably that from food only: ~1 lb safe starches and ~1 lb other plant foods, mainly vegetables, per day.

    Best, Paul

  15. Hi Paul,

    It’s me again – I asked about my yellow tongue earlier.

    Just wanted to add that I’m also experiencing some minor tonsillitis in the morning when I get up. I also have increased phlegm production. Not sure if that changes anything.

    Do you have any other ideas aside from good oral hygiene (I do that)?

    Thanks so much,


  16. Nevermind my last comment. I can’t really expect you to be able to guess what it is over the internet! I gotta find a doctor.

    Thanks very much Paul. Will be ordering your book for family members this Christmas.

    Hi Nick,

    Seeing your doctor was going to be my advice. They’re the experts in diagnosing and treating such things.

    Best, Paul

  17. Hi Paul. I wish you would create a section specifically on how to transition a family to PHD. I would love to be able to communicate with other posters who have young children and are struggling to raise them with as healthful a diet as possible. Thanks.

  18. hello paul!
    since you do not recommend l-glutamine, what is your leaky-gut prescription?
    i recently took a follow up diagnostech stool test and found that i had gotten rid of all my fungal and yeast issues, but that my SiGA was less than half of what it should be. so now i am just focusing on repairing the leaky gut and dealing with the auto-immune responses to foods. besides taking an AMP aloe supplement, enzymes, methylation assistance, and the PHD supplements, what is the PHD LEAKY GUT PRESCRIPTION? lol

    have you read jack kruse’s leaky gut prescription? http://jackkruse.com/the-leaky-gut-prescription/


  19. Hello Paul
    Is it reasonable to think there may be some optimal range for caloric intake related to body mass when body mass is normal and there is no clear evidence of pathology? My caloric intake is about 29 cal/kg and I am quite lean. From what you had said previously (if I remember correctly)your ratio is about 22. Do these numbers scale linerarly or is ther some treshhold? Thanks for devoting your time to these helpful topics

    Hi Morris,

    I think my calorie intake is, on average, close to yours. It fluctuates depending on activity levels … It seems if I become inactive for a period of time then my appetite and calorie intake may go very low … but as soon as my activity level increases appetite and calorie intake come back … if I have low activity and low appetite for more than a month I start feeling an urge to get out and move.

  20. Hi Paul,

    I will request the serum copper and ceruloplasmin tests re your advice to Molly. You mentioned a link between cancer and high copper levels. I had kidney cancer seven years ago and have been eating 1/4lb of lamb liver twice a week since I read your book. I have been told, but am not sure that it is true, that where I live (Western Australia) the soil has a high copper level. I have also lived in houses with copper pipes for many years. Six years ago I had a hair analysis done which showed a very high copper level and an out of whack copper/zinc ratio. The doctor who referred me for the hair analysis said that blood tests did not show the amount of copper in the tissues. What is your opinion of hair analysis and should I continue to eat liver twice a week? (I don’t enjoy it and it is ridiculously hard to get here.)

    Also I have just started taking a multi vitamin/mineral which has 195.6mcg of Cupric sulfate-pentahydrate equiv. to copper 50mcg. The brand is Fusion, I’m not happy with it, it contains the inferior types of folic acid and B12, but it was the best I could find here. It contains zinc amino acid chelate 75mg equivalent to zinc 15mg.

    I am so very grateful for your previous advice for other family members.

  21. Hi,

    It is easy to drain yoghurt with a (cheese)cloth. In a few hours the liquid whey is separated (about 50% of the initial yoghurt weight). Adding liquid cream to the yoghurt mass left behind makes it a smooth, rich and velvety breakfast. Is there any research on whey and if it is good or bad to not eat it and throw it away? Some say the whey can be used to cook rice instead of using water.

    Best Johan

  22. Hi Paul

    I posted about ankylosing spondylitis several weeks ago and, having read some other posts, am aware that my dilemma is probably not uncommon. It’s about a strategy for dealing with symptoms that seem to require conflicting solutions ie those exacerbated by starch on the one hand and symptoms caused by low starch on the other.

    I am juggling the inflammation of ankylosing spondylitis and gut dysbiosis (worse for starch), raised thyroid antibodies and constipation (probably both better for more starch, can’t be entirely sure), hypoglycaemia and adrenal fatigue, raised liver enzymes. Possibly candida too. Insomnia.

    I had been doing SCD/GAPS for about 7 months before I came across your website and book. I’d felt great for the first couple of weeks on low-starch then increasingly unwell – anxious, jittery, worse insomnia, constipation. So I tried implementing your recommendations, with mixed results – more grounded and solid but more inflammation and bloating.

    I have tried your suggestion of brown rice syrup, couldn’t tolerate it. White rice not tolerated. Am currently trying sweet potatoes and parsnips again but one or both of them is making me feel bad – inflammation and bloating worse, sore throat.

    So would you mind answering a few questions please?

    1. GAPS and SCD – I know that you admire the work of Dr McBride but do you think that these diets could be harmful long-term? I felt good for a couple of weeks on GAPS then fairly dreadful – worse insomnia, jittery and anxious. The only food that I know I’m definitely allergic to is honey, so I wasn’t eating that, but I have been eating squash, beetroots and carrots, plus a couple of pieces of fruit per day.

    2. If your answer to my previous question is yes then I assume an even more resounding one to Carole Sinclair’s Low-Starch Diet for IBS and ankylosing spondylitis (endorsed by Dr Ebringer) – it is very low starch but has a lot of fruit.

    3. I think that you’ve suggested that low-fructose fruits can be used to mitigate the harmful effects of necessary low-starch dieting. If so, how much fruit is it safe to eat in those circumstances? Also,there seems to be some difference of opinion from different sources about which fruits are low-fructose. For example, the FODMAPS diet excludes plums, which I think you describe as low-fructose.

    4. I think that amaranth and quinoa might be less starchy than parsnips, potaoes, white rice etc. If they are prepared as per WAPF/Nourishing Traditions
    might they be preferable to fruit as a source of glucose?

    5. Any other suggestions for people stuck with low-starch because inflammation is the worst symptom?

    Thank you Paul for all your patient and informative answers to questions.

  23. Hey Paul,

    I am a 23 year old European male. Due to a large amount of unprotected oral sex, I believe I am at high risk of having contracted HPV (16 or any of the other high risk strains) orally.

    Do you have any suggestions to reduce the risk of the HPV progressing into actual cancer (ie. throat, mouth).

    I have been experiencing some throat issues for the last 2-3 months (sore/tickly throat, lymph node tenderness and slight swelling, fatigue). In the middle of this time period, I did have a small case of strep for which I went on a 10 day penicillin regiment which seemed to just give me headaches. After the peniccilin, I was tested again for strep and the test came back negative

    I have been to the doctors, and they said it was nothing (without any actual testing other than the strep test), I will be going again and requesting a referral to a throat specialist.

    Is there any information you have regarding diet and nutrition strategies for managing throat cancer? I would like to know as I believe I am at high risk.

    Thanks Paul.

    Hi Jonathan,

    For general strategies against cancer you can see this post: http://perfecthealthdiet.com/?p=4739 and the one before that in the series.

    We’ll do more in time on cancer, but I don’t expect that diet and nutrition are highly effective.

    Best, Paul

  24. Hey guys,

    Love the work you’re doing here! Just a quick question today…

    Do you have any recommendations to bring up natural testosterone levels in an otherwise healthy young male? 31 y/o, 6’1, 180lbs. Recent lab work came back borderline low and the doctor immediately jumps to the HRT idea, but from what I understand that’s like a life sentence and I’m sure with the proper changes this can be remedied naturally.

    Thanks so much for the help!


    Hi Michael,

    Usually Paleo type diets are pretty effective in bringing up testosterone. I’m surprised a doctor would recommend HRT to a 31 year old as a first step for borderline low testosterone.

    How long have you been eating our diet?

    Best, Paul

  25. Hi Paul, Thanks for all your info has been very helpful.

    I have been doing a robb wolf paleo style diet for over a year and then switched to perfect health diet about six months ago. I have seen improvement in my health after doing both especially perfect health.

    I am currently struggling with multiple gut infections (as shown by metamatrix) H. Pylori, Candida +1, low good bacteria and endo. nana parasite. I have undergone a treatment of antibiotics for parasites and been following recommendations on your blog.

    I also live in Indonesia now, so tests are becoming harder to do. While being here I was also infected with e. histolytica and was treated with antibiotics and stool test (microscopic) said it was gone.

    When living in australia and now living in indoensia I have been also treating gut problems with probiotic enemas, which seem to help some. I am also booked into the CDD in Sydney to undergo Fecal transplant therapy.

    Anyway, thats the scope but my question is related to a slightly different matter. I have frequent night time urination problems (about 4-5 times) with tingling sensation, kind of like burning but not painful. and I also have erection problems. According to saliva test I have slightly low cortisol levels but high testosterone levels. I have found many answers for my gut problems out in the blogasphere but cannot find anything for this. I am very accepting of my conditions and understand the necessity for long term treatment. However, this issue is extremely frustrating in getting good sleep but even more frustrating is trying to have a sexual relationship with my wife for the last 2 years. I cannot find any answers, even after hours an days of searching and study (I love research) and have turned to your Q&A. I hope you or a reader may be able to help.

    I hope you have many blessings in return for the blessing you have been

    Hi Walt,

    It sounds rather like a urinary tract infection, probably from one of the same things in your gut. But I think I have to leave diagnosis and treatments to doctors here. Have you been to a urologist?

    Best, Paul

  26. hi paul,

    i am very thin 5’8 (110 lbs) with gastroparesis and some insulin resistance. i believe the gastroparesis is due to a connective tissue disorder i have called ehlers danlos. my autonomic nervous system hates me right now and i think the physiologic stress has elevated my fbg to 100-110 range (it’s been the same unless I VVLC which is too stressful on my body). i have started doing pilates.

    would you still recommend the macro-nutrient ratios for phd for me? also historically i’ve been a grazer which i’ve read (from conventional literature) is good for people with gastroparesis but i don’t think it’s good for me. I’ve noticed when my blood sugars get into the 80s I’m very uncomfortable.

    thank you! merry xmas

    Hi Holly,

    Yes, I think the PHD macronutrient ratios would still be good. It’s interesting that you don’t transport glucose well. Maybe this is a byproduct of the kind of Ehlers-Danlos you have but it might be some sort of micronutrient deficiency interacting with your disease. I would focus on being very well nourished, take plenty of supplements.

    Some steps to consider:
    – Overeat the materials for collagen synthesis. I would eat bone broth and gelatin at every meal; supplement MSM, maybe 2-4 g/day, and take Epsom salt baths; supplement vitamin C, 4 g/day in divided doses; and get sufficient starches, maybe 400-600 calories per day.
    – Take our supplement list plus some others. Pay close attention to the status of nutrients involved in glucose transport like chromium, copper, iron, sulfur. You might have a doctor measure iron/ferritin, copper/ceruloplasmin.

    Best, Paul

  27. Hi Paul,

    I have been following the PHD for several months now and have seen many improvements in body composition, overall well-being and energy levels. However my testosterone levels are still coming in borderline low, and I’d like to bring these up as much as possible.

    Would it help to emphasize carbs more, or stick with the fat emphasis?

    Anything else I can try that you’ve had success with in the past?



  28. hi paul! i realize that gastroparesis might technically be too extreme for what i have. unless you can have some mild version of it but i do have glucose transport issues and very slow digestion! i think my eds and pain levels are interacting with this.

    thank you for the recommendations. the only one of those i have checked are magnesium (i like the epsom salts idea) and my iron panel (i have out of range low TIBC and UIBC) and my ferritin (a bit low but at least it’s not high).

    i will investigate the others. thanks again! 🙂

  29. Hi Paul,

    Me again. I am at last able to go to a doctor today. I am pretty certain that it’s thrush. I believe that you are a familiar with thrush, so I just wanted to check-in and ask if you have any specific recommendations?

    I am not certain, but I believe that this thrush may have been brought on by an antibiotic I took this past August. Also, my sister recently had a vaginal yeast infection- I’m not sure if that has anything to do with it.

    Any thoughts would be appreciated. Please ask if you need further info.

    Thanks Paul!

  30. I should also note the following:
    – I have tons of phlegm production lately
    – my tongue is still yellow, and sort of white near the back
    – it affects my ears from time-to-time (e.g. clicking noises)
    – acne has gotten a bit worse, although this could be due to other factors

    Besides following Perfect Health Diet and eating fermented foods with every meal, what other steps can I take (e.g. medications)?

  31. Update #3

    Doctor said it was a bacterial overgrowth and gave me nystatin. Also wanted me to a liver lab, just in case (but she doubted anything was wrong there).

  32. @Michael

    If you’re deficient in zinc, that will lower your testosterone levels.


  33. Hi Paul,

    I’m curious about fungal infections – in my case, Candida Albicans. I’m very interested to learn more about why glucose deprivation impairs immunity to fungal infections.

    Is there some research that I can read to understand the mechanics of why it is advantageous to keep glucose at or above certain levels as well as ketone bodies at or below certain levels?

    Thanks very much for all that you do.


    Hi Peter,

    You might look up the myeloperoxidase pathway. Glucose is needed to produce the hydrogen peroxide (H2O2) that this immune pathway uses. In general, glucose is needed for generation of reactive oxygen species (ROS) to kill pathogens.

    Ketone bodies diffuse throughout the body and to pathogens and can be metabolized in mitochondria, which fungi have. So they are a highly accessible nutrient to fungi.

    Best, Paul

  34. Where is information how to implement this diet as a family–one with children?

    Hi Gen,

    We need to work on that. But here are some general guidelines:
    1) Children need more carbs and less protein than adults. So don’t deprive them of starches/carbs. Let them have some sweet tasting foods too. Direct them toward real food, not added sugar; if added sugar is used, favor rice syrup.
    2) In general, provide real, nourishing food, and let kids follow their tastes.
    3) Try to formulate meals in accordance with the food plate.

    Are you looking for practical cooking advice or meal plans?

    Best, Paul

  35. Hi Paul

    Could you please advise on how much fruit it’s ok to eat as a source of glucose if unable to eat starch.

    Also, could blackstrap molasses be a reasonable substitute for starch (haven’t tried it so don’t know if it would agree any more than rice sytup) ?

    Thank you

    Hi Frances,

    Fruit has about 200 carb calories per pound and you want about 400 carb calories per day, so if you must obtain carbs from fruit, then I would recommend about 2 pounds (1 kg) per day.

    The other alternative is to eat pre-digested starches, eg rice syrup, which are better absorbed and lack fiber. This will help keep your fructose intake down, which is good. So you could put rice syrup on cream and berries, for instance.

    I’m not a fan of molasses. If you must have a fructose sugar, I would suggest unprocessed honey.

    What is the reason you can’t have starches? Some sort of digestive ailment?

    Best, Paul

  36. Hi Paul,
    I am hoping to get your opinion after some recent blood work. Please let me know if I should post this somewhere else. Thank you for your time.
    Q #1: Elevated Bilirubin & Lactate Dehydrogenase (LDH)
    My annual 12 hour fasting blood test that I took last week for work showed elevated levels of Bilirubin 1.3 (was .9 over the summer and 1.1 last year). Sounds like this could be because of fasting but I have always been below the 1.2 threshold. My Lactate Dehydrogenase (LDH)was 255 IU/L in prior years it was in the 180s. These numbers have never been high before. Outside of my lipid profile the rest of my numbers were “normal”. In early July I was bit by a lonestar tick. A couple of weeks after the bite I was bedridden for 3 days with extreme fatigue, 102+ fever, and chills. All tests came up negative and normal (including my Bilirubin and LDH numbers at the time). The Dr’s best guess was some form of meningitis. Outside of those few days in July and the above test results I feel great but I am wondering if you have any precautionary dietary recommendations based on the information above and if there might be some correlation. I have been fallowing the PH diet since I read your book in August but I am only taking the core supplements. Probably worth noting I tested positive for Lymes disease in 2008. The only side effect was a swollen bull’s eye around the bite. Yes… I know… ticks love me.
    Q #2: Lipid Profile: 2011 (2010)
    Cholesterol, Total: 279 mg/dl (264) Triglycerides: 60 mg/dl (140)
    HDL Cholesterol: 69 mg/dl (58) **has never been above 60 before.
    VLDL Cholesterol: 12 mg/dl (28)
    LDL Cholesterol: 198 mg/dl (178)
    Four months of PHD has me seeing much better numbers but my LDL went up. I am wondering if there could be any correlation between the higher LDL and the elevated Bilirubin and LDH numbers. Would you suggest any diet changes / thyroid tests (My TSH was 3.660 uIU/mL) given the numbers above? As mentioned above, I am following PHD with the core supplements (currently at 1.5 mg of iodine and plan to jump to 3mg next month). What is the PHD normal Total/LDL Cholesterol range? I know Cholesterol is covered in various areas in the blog and actually recall seeing the answers somewhere before but now I am struggling to find them.

    Hi BG,

    Your case is a good example of a common medical situation with no standard response. You have definitely been infected in your two tick bites. Many tick-borne pathogens cause an immediate acute illness like the one you experienced, but then can establish persistent chronic infections with mild or minimal symptoms, but the infection may flare or become serious at some time in the future.

    In your case, the elevated bilirubin and LDH are both consistent with destruction of red blood cells, which can occur in various infections (see http://en.wikipedia.org/wiki/Hemolysis). So it’s quite possible that you caught one of those infections from your recent tick bite.

    Given the likelihood that you are still infected with something, I personally would try a course of antibiotics. This is meant to treat a possible infection raising bilirubin and LDH, but also as prophylaxis against whatever bacteria the ticks gave you. So I would look for a combination of antibiotics that works against the likely pathogens.

    Normal cholesterol levels are: TC, 200 to 260 mg/dl; HDL, 60+ mg/dl; LDL 80 to 160 mg/dl. TG, 40-80 mg/dl; VLDL, low.

    Your lipid profile is generally good but as you say LDL is a bit high. However, the rise since 2010 of only 20 mg/dl is sort of in the noise, it’s not obvious that whatever factor is causing it is recent. Elevated LDL can happen in infections; other causes may be that you’re too low in carbs, that you lack some appropriate micronutrition (zinc would probably be the most likely candidate if you’re doing all of our recommended supplements), that you are mildly hypothyroid (perhaps a temporary reactive hypothyroidism in response to recent increases in iodine, or an infection-induced hypothyroidism). In your case, the TSH of 3.66 is high and indicates a mild hypothyroidism, so I would say that or the infection is the most likely cause. (The infection could be causing the hypothyroidism.) Do you have a history of TSH levels?

    My inclination would be to continue elevating iodine, but very slowly. Stick to 3 mg for maybe 2-3 months, and monitor TSH.

    So I would say that infection and hypothyroidism are your two major issues, and would address the infection first and see if that fixes the hypothyroidism.

    Best, Paul

  37. Have you thought of formatting this page as a forum? You have lots of great info, but I find it hard to read through/find what I’m looking for.

    I’m sure there are other forums out there but I’ve seen http://tal.ki/ used before.

    Hi Ashley,

    Thanks for the suggestion. I think if the site continues to grow in popularity I’ll need a forum so that readers can answer each other’s questions. I haven’t really looked into options yet however.

    Best, Paul

  38. @ Ashley

    Use ctrl-F

  39. Hi Paul,

    I had a question about raw milk and lactose intolerance. I am lactose intolerant so I decided to try raw milk, yet I still seem to have indigestion. I’m confused as to why this would happen if the lactase enzymes are retained in the raw version. Also, even with this problem, can i still consume the milk if i wish to assimilate these great nutrients at the cost of some digestive discomfort–or are there other consequences?

    Hi Jason,

    You need to eat yogurt and fermented vegetables to add Lactobacillus bacteria to your gut, then add milk slowly. If you regularly drink milk then your gut will gradually adapt to it. But start with very small quantities, taken regularly.

    The only negative consequences are that the sugars may be feeding improper species of bacteria. So you want to populate your gut with good species and give them time and consistent nourishment so they can grow.

    Best, Paul

  40. Hi, Paul. I have a quick question for you about healthy fats.

    As we’ve discussed elsewhere, I am recovering from a Candida infection and have somewhat fragile gut flora. For these reasons, although I love coconut oil (ketones make my brain happy), I probably shouldn’t consume big quantities of it. I am allergic to dairy, so I also can’t eat a lot of butter.

    Can you recommend an oil or fat that is dairy-free and not too expensive, contains minimal omega-666, and (unlike coconut oil) will not kill off my friendly commensal bacteria? Would palm oil fit these criteria?

    Thank you, Paul. My gut bacteria are doing better thanks to your advice, and I’d like to keep the little guys happy and healthy.


    Hi Vincent,

    My top recommendation would be rendered beef tallow. Beef fat can be obtained cheaply from many butchers, they discard it mostly.

    You may find that you tolerate ghee (clarified butter) just fine, since it is the proteins that cause the allergy.

    Palm oil is excellent.

    Best, Paul

  41. Dear Paul, are you against having (non-fermented) cod-liver oil even if one doesn´t eat liver at all? I cannot bring myself eating liver without wanting to throw up, regardless of what I put into it to mask the taste. Maybe I should supplement with CLO, but not every day? I am currently supplementing with 1000 I. U. of vitamin day (the highest dose available to me, but I could easily take more caspules to increase the dose) so vitamin d/a balance should not be an issue. Would you mind making your stance on CLO clear? Thank you very much!

    Hi Iris,

    If you don’t eat liver, then I think taking some cod liver oil is good. But I would get liquid CLO in a bottle, not capsules. Find one of the cheaper ones that still has vitamin A, and take one teaspoon a day, that will have 4,000 to 5,000 IU of A and a reasonable amount of omega-3 fats. Try to get 3 egg yolks a day as well.

    Best, Paul

  42. Hi Paul,
    From reading your book, it appears to me that you are not really a proponent of organic meats. Or at least you don’t insist on them. I find that difficult to understand with all the information about regular, store-bought Grain-fed animals being so unhealthy to eat. I want to start eating liver but it’s impossible to find organic liver unless I order it on-line and I never seem to get around to doing that. So I end up NOT eating so many different cuts of meats, including meat bones. I haven’t added that to my diet either because I can’t find organic meat bones in the stores including my health food store. I would love to get your advice on this problem. Thank you so much in advance.

    Hi Isabel,

    We don’t insist that meat come from naturally-fed animals but it is preferable, especially for organs that may concentrate toxins, like the liver and bones. For muscle meats it doesn’t matter as much.

    I would suggest investigating your local farming community – look for farmers markets or Google farmers, call them up and ask them where you can get organic meat bones, organ meats, and animal fat.

    Best, Paul

  43. Hi Paul,
    Thank you very much for your response to my Dec 13th 2011 questions.
    Regarding my tic bytes and hemolysis:
    I will work with my Dr to explore antibiotics. I was given a high dose of Doxycycline for two weeks while I had my fever in July (I don’t recall the exact dosage). Based on initial review it sounds like some antibiotics can cause short term Hemolysis as well. Interesting. I went back and found my prior LDH/Bilirubin history for reference:
    Dec-08 211 1.2
    Dec-09 182 1.1
    Dec-10 NA NA
    Jul-11 NA 0.9 ** Was not fasting.
    Dec-11 255 1.3
    Regarding my LDL:
    After reviewing some of the other PDH posts I think low carbs may also be an issue for me. My average intake is generally around 125 grams but I am 6’4 190lbs (down from 205 after starting PDH in August) and work out 4-5 times a week (30 min runs, 1-2hours cycling, 30 min circuit training with weights). My energy levels are generally good but I will play around with my carb intake too.
    Unfortunately I don’t have any historical results for TSH (just the dec 2011 value 3.660 uIU/mL).
    Historical Lipid info for reference:
    LDL Triglycerides HDL Total
    Dec-08 158 172 57 249
    Dec-09 152 76 59 226
    Dec-10 178 140 58 264
    Dec-11 198 60 69 279 *** Started PHD in August 2011.

    Hi BG,

    That carb intake should be adequate but is a bit marginal for an athlete, I do think it’s worth trying more carbs to see if that has an impact.

    Best, Paul

  44. Hi Paul

    Thank you so much for your reply. The problem with starches is ankylosing spondylitis (inflammation,fibromyalgia) and gut dysbiosis. I’ve been doing GAPS/SCD since April and still get bloated with squash, beetroots, carrots and a couple of pieces of fruit but the AS inflammation is fine with that.

    The trouble is that I’ve got a very high level of thyroid antibodies and I think GAPS/SCD doesn’t help. I sometimes feel jittery, anxious, irregular pulse which are symptoms I never had before low carb.

    I came across your website and bought the book and it makes so much sense, I would love to be able to implement PHD properly. But all the safe starches, incl rice syrup, caused bloating and AS symptoms to return.

    I was so glad to come across the reference to Alan Ebringer’s low starch diet in your book. However, I don’t feel that his diet (also Carole Sinclair’s book endorsed by him) is good for me metabolically, although I get less inflammation on it.

    So a rock and a hard place, trying to find the best strategy overall and minimise potential for long-term damage.

    2lbs per fruit a day is a lot, love the idea but a bit nervous about blood sugar and also have found the glucose/fructose fruit tables totally confusing so not even sure which to go for, apart from berries which are seasonal and expensive.

    Thank you so much for taking the time to reply, the stuff on this page is fascinating.

    Hi Frances,

    It is a lot. Since you don’t tolerate any carb source well, try giving yourself coconut oil or MCT oil to promote ketone generation, which may mitigate a glucose deficiency.

    I would start making fermented vegetables (to help improve your gut flora) and consider antibiotics.

    Best, Paul

  45. Just finished the book and very excited to start detoxing my kitchen! I’m a bit confused on the amount of calories and the breakdown of carbs and proteins.

    In one section of your book you talk about a 2000 calorie diet and in another a 2481 diet (when you compare obese to non-obese calorie burns) and I understand everyone’s diets will be different, but…

    On a 2400 calorie diet – if I stick to 15% protein as you say, that’s only 360 protein calories and you’ve stated on page 27 in your summary on protein, “intake of 200 to 600 calories per day seems to be a healthy plateau if sufficient carbs are eaten……a window of 500 to 600 calories if carbs are restricted.

    I guess my question is: if I restrict carbs for weight loss, do I add the “extra” calories to the protein totals, or the fat totals?

    Thank you for your help and the book, which I feel is a godsend right now in my life!

    Hi Dawn,

    Well, you shouldn’t restrict carbs for weight loss. Our diet is already low carb and the amount of carbs is designed to nourish you optimally, so you lose weight by restricting fat, which reduces total calories and causes your fat needs to be met from adipose tissue rather than diet.

    For more on this see “Perfect Health Diet: Weight Loss Version”, http://perfecthealthdiet.com/?p=2145.

    A good weight loss diet is 400 carb calories, 300 protein calories, and >500 fat calories, for 1200+ total calories. I don’t recommend going below 1200 calories/day as it is almost impossible to be well nourished below that, and good nourishment is more important than calorie restriction.

    The main reason why some people should restrict carbs is not for weight loss, but because of infections or neurological disorders that benefit from a ketogenic diet. Diabetes can be another reason.

    Best, Paul

  46. Thanks for that Paul, interesting.

    I just read another post from Vincent re coconut oil killing off friendly bacteria. I had no idea about this and have been eating coconut oil, not usually in vast quantities but sometimes having your recommended 2 tbsps per day. Should I then go for ghee and lard?

    It seems like quite a complicated business to juggle the different factors to produce a therapeutic diet.

    Hi Frances,

    Coconut oil is fine. The friendly bacteria are in the colon, coconut oil is digested before then. Coconut oil will be antimicrobial in the small intestine, but that’s a good thing.

  47. Hi Paul,

    I’ve got a colleague with kidney stone issues. He’s received the traditional oxalate diet sheet from the doctor but “everything” is on the list that his family (wife and son) eat. What is your PHD recommendation?

    Hi Craig,

    First, read this: http://perfecthealthdiet.com/?p=1177

    In general I think our diet is very good for kidney stones. You want to get enough starches/carbs, but not an excess – say 400-600 calories per day. Normal amounts of protein, neither too much nor too little – 300 calories a day is good. Avoid omega-6 fats, get enough omega-3s to balance. And be very good about micronutrition. Supplement all our recommended supplements.

    A few keys specific to kidney stones:
    – Lemon juice. Citrate helps dissolve stones or prevent them from forming.
    – Antioxidant supplements, especially minerals. Oxidative stress forms oxalate. Glutathione or NAC, selenium, zinc, copper, manganese, vitamin C, alpha lipoic acid, CoQ10, vitamin E (low dose mixed tocotrienols) should all be good.
    – Sufficient salt and water. This will help excrete/flush the kidneys. Hydration is important.

    Best, Paul

  48. Hi Paul —

    Going no sugar, no flour, mainly paleo with coconut oil over the last several months, I was able to get rid of chronic fungal discharges (apparently due to candida) from my ears, which had plagued me for several years.

    I’ve also noticed that I’ve stopped having “night sweats”, another chronic problem.

    Do you think there’s a connection between candida and night sweats?

    Or is the diminishing of my night sweats due to abstinence from flour and sugar?

    Be curious to get your opinion on this.


  49. Sheep Counteress

    Hi Paul,

    In answering Craig Wright’s question about kidney stones, you say, “You want to get enough starches/carbs, but not an excess – say 400-600 calories per day.” Is excess a concern for stones as well, or more general health concerns?

    Previously, you advised me that my father should eat relatively more starch than fat because he had his gallbladder removed. He has always eaten a lot of starch (substituting in the right ones is evermore the ongoing project), way more than 400-600 calories per day. Forcing that number down is difficult because he still has the entrenched fear of solid fats. So do you believe risk of stones from starches is also a U-shaped curve?

    He has already lost both vestigial organs, and his brother has had kidney stones; I hate to imagine what else is down the line.

    I am also having problems with getting him to take the recommended supplements (you mentioned C, magnesium, and a few others). He is still convinced the nutritional yeast is good for him, and trusts it because it is supposedly made in Europe. The main issue is that he thinks all vitamins are made in China or with components from China, unless labeled otherwise, and thus dangerous. Do you know of any resources that testify to the safety of certain brands of supplements? I found consumerlab.com, but unfortunately, that requires a paid membership.

    Also, a general question: does anyone have experience getting very strong-willed family members on board with PHD, especially those who already have very rigid conceptions of what the correct diet is? I would greatly appreciate your tips!

    Hi SC,

    I’m not aware that high-carb diets are risk factors for stones. I favor 400-600 calories from starches on evolutionary grounds, I think it’s optimal for overall health, but with a gallbladder missing I would go higher carb.

    I understand the concern about Chinese products. I’m not sure whether there is an authoritative source who has investigated those issues, or could guarantee vitamin quality. Perhaps other readers can advise us.

    Best, Paul

  50. Sheep Counteress

    Also, do you think there is something to the inability to handle sour tastes? With Chinese medicine, we think taste preferences are indicative of our nutritional and overall health status. He won’t eat fruits that he says are too sour, even when they are very ripe and sweet, so I’m not sure about the lemon juice for preventing stones. Or do you think it’s mostly a psychological thing? Thanks!

    Apparently it’s pretty common for the elderly to develop a sweet tooth: http://www.eldercareteam.com/public/397.cfm. There are a number of taste and smell changes in the elderly: http://www.healthmegamall.com/Articles/BabeskinArticle247.pdf.

    I’m not sure what would account for avoidance of citrus, though.

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