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. Thank you so much for your quick and detailed reply. I will take all your advice and continue on. I can’t tell you how much I appreciate it and how motivated I am.

    You maybe onto something about inflammation. This was my
    22 mm/h
    Range < OR = 15 mm/h

    The RA didn't seem to concerned and said that I didn't have RA and that was that.

    This is blood work from 3/20/2017
    F CHOLESTEROL 147 (mg/dL)
    F HDL CHOLESTEROL 27 (mg/dL)
    F TRIGLYCERIDES 167 H <150 (mg/dL)

    My HDL cholesterol has been low going back to 2011 when I first learned of it.

    I had a comprehensive metabolic panel on 5/2/2017 everything was in range accept
    12.2 H
    3.8-10.8 (Thousand/uL)

    9382 H
    1500-7800 (cells/uL)

    I am told this is most likely the extreme amount of stress/anxiety I have been under over the last few months. Going back to the previous CMP before then on



    I know stress is really bad for Inflammation so I am trying to reduce that with exercise/meditation/healthy diet

    I do want to be positive though cause my health has improved a lot from PHD, I have lost weight, my sleep has been cut from 12 hours a night to an average of 9. I am on 1 high blood pressure medicine vs 2 previously. My depression is not as overwhelming. I do have sleep apnea and have been treated with cpap since 2013 and that is improving as well. So thank you again for giving me hope that Nutrition can drastically improve health and heal the body.

    Your book is so loaded with facts I think it is time for a second reading so I absorb everything and make sure I am following standard PHD. I have done a lot of reading and listening to health podcast online as well so sometimes I mix advice up or don't remember where I read it.

    I will take your advice and follow standard PHD lowering my fat intake and increasing my carbs. I have been eating 5 eggs every day but will go to 3. I have been taken the recommended supplements, I have raised my vitamin D from 26 to 40, Taurine seems to be the best at helping with fatigue. I take iodine and my thyroid is extremely healthy. Your advice on supplements has been extremely helpful as their is a tendency to overdue and take to many supplements so your guidelines on what to take weekly/daily have really helped. I havn't been able to will myself to eat liver yet but that's my next big step. I will take your advice and not be so low carb, I have been gluten free since January and only source of carbs are rice/ potatoes or gluten free products but it is very low under 60 grams most days. I will increase to 160 as recommended in PHD. I also need to increase and eat more of the recommended vegetables which has been the largest challenge. Now that the weather is increasing in the Northeast I will get more sun exposure as well.

    Thanks again for your advice and help.

    • Hi Patrick,

      Well, I would say you most likely have some kind of chronic infection. The WBC count of 12.2 is almost triple the number of 4.5 that would be seen in an infection-free person, and the SED rate indicates chronic inflammation as in the response to infection. Your cholesterol levels are alarmingly low. Total cholesterol should be 220 mg/dl, HDL should be 70 mg/dl, LDL should be 130 mg/dl. Your extremely depressed LDL and HDL levels suggest a possible eukaryotic pathogen, e.g. protozoal parasites such as cause malaria, Chagas disease, sleeping sickness, and many other diseases, mostly of tropical origin (did you travel in the tropics?). I think you should seek out an infectious disease doctor, ideally one who has experience with tropical diseases.

      Best, Paul

      • I have not traveled abroad or to a tropical area, . I will find a infectiois disease doctor asap. I live in your state MA so if you know a good one please let me know.

        • OK. Some other things to look at are gut dysbiosis or infections. You might want to ask for mebendazole as a routine de-worming step, this is routine in the tropics. Get iron status tested to check for anemia. I know you said your thyroid is fine but doctors underdiagnose thyroid issues. TSH should be 1.5-2.0 for most people, I would expect that it would be out of range for you with your other health problems.

          Best, Paul

          • Thank you I have an appointment in a few weeks with an infectious disease Doctor at a top hospital in Boston. My thyroid was checked on 3/21/17. Here are the numbers

            FREE THYROXINE 1.09 Range 0.61-1.72 (ng/dL)
            TSH 0.62
            Range 0.34-4.8 (u/IU/mL)

            So that range is lower than the 1.5-2.0 you mention.

            I really appreciate your help. I am around dogs a lot so maybe that could spread this type of thing?

          • Hi Patrick,

            OK. This is looking like hyperthyroidism which will bring down your cholesterol. I think you need to avoid iodine until the thyroid heals.

            Best, Paul

          • Yeah hard without all the information. So do you think it isn’t an infectious disease with those numbers? Just follow PHD and avoid Iodine and it should improve over time?

          • You have been really helpful so I will just list other blood work that give more information. The Perfect Health Diet has giving me a lot of hope.

            The other blood work from a few weeks ago out of range but not by much is

            Calcium 10.8 mg/dl (normal range 8.6 – 10.3)
            Albumin 5.2 g/dl (normal range 3.6 – 5.1)
            Protein, Total 8.3 (normal range 6.1-8.3)
            Ketones 1+

            In range but you asked.
            HEMOGLOBIN 16.2 (normal Range 13.2-17.1 g/dL)

            Any specific things I can do to improve my thyroid?
            Do you think this is more likely to be thyroid issue than infectious disease?

            Could my high WBC be because of extreme stress of being worried I am really sick and anxiety?

            Thanks again for all your help I really appreciate it.

          • Hi Patrick,

            I don’t think your high WBC count can be due to stress. I think you have an infection. The question is whether you have two issues, the infection causing the inflammatory response and hyperthyroidism causing low cholesterol, or one problem, the infection causing both. If the latter then the infection is more likely to be eukaryotic, probably a protozoa or worm.

            I think it’s very easy to be stressed and anxious when you are sick, and it is more likely the infection causing the stress and anxiety than the other way around.

            Best, Paul

          • Paul I just had a terrible realization. I have been using Clindamycin lotion and gel for the last two years for Hidradenitis suppurativa. I did not realize it was an antibiotic. My dermatoligst prescribed me both the lotion and gel Monthly so I would have plenty to use. Not sure if this changes things. Could this be the cause of a long lasting chronic infection? If this is the cause what can I do to heal.

          • Hi Patrick,

            The lotion might promote fungal skin infections. If you have a systemic fungal infection the extra fungal load would exacerbate that. You might be better off discontinuing the antibiotic lotion and instead using AOBiome’s Mother Dirt skin probiotic.

            Best, Paul

        • Patrick,
          Hidradenitis suppurativa may be an autoimmune disease. Many HS sufferers find that eliminating all nightshades from their diet eliminates the HS (though some other food might cause the problem). Nightshades include white potatoes, tomatoes, eggplant, chilies, and capsaicin-containing peppers such as paprika and cayenne; and paprika can sneak into lots of prepared foods.

          Searching on “Hidradenitis suppurativa
          nightshade” will produce lots of pages to check out. The best I found on a quick search was a Loren Cordain page:

          Hope this helps. If you’ve already been-there-done-that to no avail — nevermind!


          • Thanks Paul I will keep you updated on progress and try the Mother Dirt Skin Probiotic. I really appreciate all your help and am staying hopeful that things will improve.

            Thanks MizPat I should try avoiding nightshades. I will say that my Hidradentis Suppurativa has improved with PHD and loosing weight but I can try that as well.

            I left my dermatologist last year. He put me on the Antibiotic Doxycycline the end of 2015 to treat my Hidradentis Suppurativa and they didn’t work. After 3 months I complained that I was having issues because of the antibiotics and said I stopped taken them. He just looked at me and said “That doesn’t surprise me antibiotics can wreck havoc on some people” I felt like saying thanks Doctor for letting me know the potential side effect ahead of time.

            After that he prescribed me Humira which fits in with your autoimmune thing. I went home did research and said no way am I taken Humira with all the potential side effects. It didn’t stop the specialty pharmacy from calling me over and over again trying to deliver it to my house which I had to refuse. That experience along with some others with doctors is what finally motivated me to take action myself and change my lifestyle, eat healthy and exercise more because I realized Doctor’s can’t always fix you and sometimes they can make things much much worse.

  2. Hey Paul,

    First of all, thank you for all your work, it has been of tremendous help to me and my family. I’ve been eating PHD for a few years now with about an 80% compliance rate. So about four out of every five meals will be PHD, but I’m a bit of a foodie so when there’s great pizza or sandwiches around I tend to cave. I take all the recommended supplements, but I have a hard time getting in 3 yolks a day. When I don’t I try to supplement choline. I also have a hard time entraining circadian rhythms. I’ve always been a night owl. I’ve never been diagnosed with delayed sleep phase disorder, but it greatly resembles what I deal with. Left to my own devices I will go to bed later and later each night. Mostly I keep it under control and end up falling asleep at about 3 am and waking up at 11am. I sleep in a completely darkened room. So it’s a somewhat regular sleep pattern but it’s just shifted later than most people’s. Generally my problem is in falling asleep and less so in staying asleep. Recently I had a run of time where I was consistently waking up too early and couldn’t manage to sleep more than five and a half hours. I reviewed the literature on your site and found Seth Roberts’ experiment with intermittent fasting and early waking. By no coincidence I had stopped intermittent fasting in the few months leading up to this problem. I started the 8/16 fasting protocol again and the early waking went away two days later. So I recently got my labs from my doctor and wanted to ask you about my sluggish thyroid:

    TSH: 2.0
    Total Cholesterol: 220
    LDL: 152
    HDL: 46
    Triglycerides: 110
    Non HDL, Chol, Calc: 174
    Vitamin D: 35 ng/Ml
    Glucose: 98 mg/Dl
    White Blood Cell Count: 6.47
    RBC: 5.09

    My question is, at what point with TSH does one start to suspect Hashimoto’s? Is it worth me getting tested for that, or should I just assume I need to up my seafood/seaweed consumption and wait for increased iodine to take care of my thyroid? My main hyper-thyroid symptom is that I sweat constantly under my arms (very annoying) but I’m also overweight. I weigh 220 and am 6’1”. I’ve also been considering slowly upping my iodine intake to 1mg a day from 225mcg but I know you don’t recommend that anymore. I feel like I’m so close to having really good PHD labs and am just looking for advice on what my next steps should be to correct my thyroid, which in turn should help me keep losing weight and shift my blood lipids towards the recommendations in your book. Thank you Paul! I hope Angiex is going well for you guys.



  3. Hi Paul, or other commenters in the metro-Boston area,

    Do you know of any restaurants in Cambridge, or more generally the metro-Boston area, that use only PHD-approved oils?

    (I’m asking specifically about oils because usually other problematic ingredients are relatively easier to notice, and thus avoid, from menu descriptions.)


    • I think it’s almost impossible to find a restaurant anywhere that doesn’t use canola/rapeseed oil.

      However, we live in a small town in Scotland and our local Indian restaurant only cooks its curries in olive oil. Which I’m delighted about!

      You could ask for your meat/fish to be cooked in olive oil I guess if you said you were allergic to rapeseed oil although I haven’t tried this anywhere myself.

    • Jonathan M Grodi

      Look up Corelife eatery. A couple locations just opening here in Ohio.

  4. Hi Paul,
    I was under a period of tremendous stress, out of town for work with long hours. Over 6 months, my BMI dropped from 24.5 to 23.5. I could barely get out of bed and I noticed some hair loss in the last month. My TSH number is usually around 1, it was .52 this time. The other labs seem to be decent, TC=180, HA1bc=5, FBG=83, Free T4=1, Free T3=3.3
    I’ll be de-stressing and leaving this work for my body to calm down. Can you explain what this lower TSH number means, is it better to be on the lower range for TSH and is there anything else I can do to stop/reverse the hair loss? Thank you.

  5. Hi Paul,

    I’m a bit confused by the math in the section titled “The Optimal Amount of Fiber” (page 165 of the book or at least of my edition thereof). You wrote:

    “Human breast milk provides 3 percent of energy as oligosaccharides, the milk equivalent of fiber… Most plant foods have about 8 to 10 grams of fiber per pound… To reach 3 percent of energy from fiber, [Americans] would have to eat 7 or 8 pounds of plant food per day. That’s a lot!”

    First of all, how did you get from 3% energy to ~70 grams of fiber? Am I wrong that fiber gives 1.5 calories per gram, which would give 3% energy = 60 calories = 40 grams of fiber?

    Second of all, does the “average PHD plant food” really only provides 8 to 10 grams of fiber per pound? For example, the 4 pounds of plant foods I ate today provided 62 grams of fiber, according to the USDA database. And I don’t think the collection of plant foods I ate today — sweet potato, taro, winter squash, banana, guava, spinach, watercress, shiitake mushrooms, oyster mushrooms, cauliflower, avocado, kimchi, nori seaweed, coconut milk, dark chocolate, macadamia nuts — was that abnormal for PHD.

    Anyway, if 3% of energy is 40 grams of fiber, and the average PHD plant food provides 15 grams of fiber per pound, that means 3% of energy would correspond to approximately 3 pounds of PHD plant foods on a 2000-calorie reference diet (as PHD recommends).


    • Hi Eric,

      It does look like we made a simple arithmetic error. I must say though that it is gratifying that the theoretical claim that breast milk is a good guide to the evolutionary optimum diet seems to be well supported by your analysis … and that PHD dietary advice, arrived at for other reasons, may give the optimal amount of fiber!

      Best, Paul

      • Hi Paul,

        OK, great!

        On a similar topic, do you have any idea why breast milk contains so much pantothenic acid?

        Scaled to body weight, it’s the equivalent of 20 mg for a reference adult. By comparison, the average PHD animal food provides about 7 mg per pound (less if mostly muscle meats are eaten); and the average PHD plant food provides about 2 mg per pound. So to reach that level of intake on PHD, you’d need about 6 pounds of low-calorie vegetables (or “only” 3 pounds if vegetables high in pantothenic acid are preferred).

        Breast milk of all mammalian species, bird egg yolks, fish eggs, and royal jelly, are all quite rich in pantothenic acid — suggesting the explanation should be universal to the entire animal kingdom.


        • ** the average PHD plant food provides about 1.5 mg per pound

        • Hi Eric,

          The pantothenic acid is for production of Coenzyme A. This is a required intermediate in fatty acid metabolism and in production of ketones. Ketones in babies are an essential pathway for lipids to get into the brain to support brain development, ketones are made in the liver and diffuse into the brain where they can serve as substrates for synthesis of fatty acids or cholesterol or other lipids to support brain growth. Also you have to augment the Coenzyme A pool as you grow, which is not important in adults. So the need for pantothenic acid is higher in babies than in adults.

          Brain growth is higher in humans than in animals, but body growth rate is lower (e.g. human neonates are growing in body weight at the same rate as weanling mice and rats, i.e. 8 week postnatal mice or 12 week postnatal rats), so the pantothenic acid requirement is elevated in all species.

          Best, Paul

      • Hi Paul,

        Actually, your original answer of 7–8 pounds of plant foods is almost correct… The key function of human milk oligosaccharides is their fermentability, so insoluble fiber (which isn’t fermented in the GI tract) shouldn’t count towards the total.

        The fiber in the average PHD plant food is probably about 40% soluble (in contrast to the grain-based diets of most Americans in which only about 25% of fiber is soluble). So my answer of 3 pounds of plant foods is off by a factor of about 0.4; the “real” answer is 3 / 0.4 = 7.5 — so 7–8 pounds of plant foods, just as you said.

        Which is absurdly high — I think the reason is that this calculation neglects resistant starch, which is also fermentable.

        The resistant starch content of PHD starches is quite variable, typically between 10% and 25% of the total starch (by eyeballing the table that Richard Nikoley put together here: https://freetheanimal.com/wp-content/uploads/2013/08/Resistant-Starch-in-Foods.pdf). If we take the midpoint of that range, then that suggests that PHD provides about 18 grams of resistant starch per day — the equivalent of the soluble fiber found in 3 pounds of PHD plant foods!

        So the real answer for what breast milk is equivalent to should be 4–5 pounds of PHD plant foods, as low as 3 pounds if your main safe starch was steamed-and-cooled-but-not-reheated potatoes (which provide about 25% of total starch as resistant starch).

        Also potentially relevant: Human breast milk, this time scaled to body weight, provides about 2 mg / day of thiamin, 20 mg / day of pantothenic acid, and 450 mg / day of vitamin C (which also happens to be about the intake where absorption stops in young healthy individuals as you note in the book); these are the nutrients I found most difficult to reach an equivalent intake from PHD foods. Of course, probably 20 mg / day of pantothenic acid is not necessary, as we discussed above, but it’s difficult to guess at what point benefits end. So if you were to preferentially select fruits and vegetables rich in pantothenic acid, without paying attention to their thiamin content or vitamin C content (except insofar as they happen to be slightly positively correlated with pantothenic acid content!) — then you reach 2 mg / day of thiamin after eating about 4 pounds of PHD plant foods, and 450 mg / day of vitamin C also after eating about 4 pounds of PHD plant foods; at this point, you’ve consumed about 15 mg / day of pantothenic acid. (By contrast, you reach 4700 mg of potassium after eating between 2 and 3 pounds of PHD plant foods.)


        • I do not own the PHD book, but I haven’t read anywhere on this site, at least not yet, where Paul has indicated that adult humans should closely calibrate their diet/nutrition to what is in human breast milk.
          To best support their health, growing children need slightly different things (nutrients and stuff) than adults do.
          Men and women need slightly different things from each other, people with different genetics need slightly different things, people with different diseases need slightly different things, people in different climates, people with different occupations, people who do different physical activities, etc.
          If mammals did best subsisting on breast milk after childhood, nature probably would have worked out a way for that to continue. [And, as a woman myself, I say thank goodness for that! ha 😉 ]

  6. Hi Paul,

    In your book you mention about the body composition in percentage between the macro-nutrients. For muscle, its more than 50% fat. I see that all the cells have phospolipids for cell membranes, but where else would fat be present? any difference here between muscle cells and other cells in terms of the amount of fat and where it is present? I could not find reference links on this topic in the book. Am curious to see how fat is present, although it looks completely logic to me that muscle is a good storage of fat for energy..


    • Hi Naveen,

      You can follow references for the book here: http://perfecthealthdiet.com/notes/.

      One thing to keep in mind is that the body composition percentages in the book are in terms of calories, not weight. Fat has 9 calories per gram, protein 4, so 50% fat by calories corresponds to about 25% by weight.

      Since the meat we buy in stores is similar in calorie composition to human muscle, you can use that as a conceptual reference point.

      Note that muscle is lower in fat than the body as a whole, so while it is a good form of storage, one wouldn’t want to be too lean.

      Best, Paul

  7. About fasting, I read that in the morning you can take coffee or coconut oil, but cant find the quantity of coconut to take if we dont take coffee and its not in the fasting section of the book. Anyone?

  8. I recently read that you should add a small amount of baking soda with your apple cider vinegar and water to receive the full benefit. Is this true?

  9. Hi Paul I have a question. I’ve been on here a few times sharing my story. I’ve been PHD about 15 months. Since then I’ve lost about 30 pounds but I recently got street throat yesterday. My Dr took my blood pressure and it was 140/90 which was concerning to me. It does run in the family but because I feel so great I would never imagine my BP being that high. Especially after losing 30 pounds and having a wonderful workout schedule consisting of cardio and heavy weights. Any suggestions would be helpful. I know your blood pressure rises when sick but this number was concerning to me. It does run in my family.


    • Hi Bob,

      140/90 is too high (110/70 or 100/60 would be better) but it’s hard to assess with one measurement taken when you are sick. BP can be highly variable. You might want to buy a blood pressure measurement kit and measure yourself periodically, these are about $10 if you can do it manually or $30 with digital measurement. Be sure that you are not dehydrated and are getting adequate water, salt, and potassium.

      Best, Paul

  10. Hi Paul,

    For people who take Choline supplements (I take 550 mg a day) instead of eggs, in addition to taking plain Choline Bitartrate, would you recommend taking a plain Inositol supplement (if so, what dose?), or would you prefer a Phospholipid complex supplement such as the one in the link below (if so, what dose?).


    Thank you,

    • Paul,

      I will ask again this way, I do not eat eggs and supplement 550 mg Choline (as bitartrate) daily, but I do eat 1/4 pound beef liver per week. Do you think the Phospholipids and Inositol provided by the beef liver is enough in my case? Or should I still supplement a Phospholipid complex and Inositol?

      If I should supplement Inositol, do you think 500 mg a day would be too much? How about supplementing 1500 mg Inositol once a week? Which approach would be optimal?

      Thank you

      • Hi John,

        I think food (egg yolks and liver) are the best source. If you want to replace the egg yolks with supplements, then a phospholipid complex would be best. You can also supplement choline and inositol, the amount of choline should be at least double the amount of inositol.

        Best, Paul

  11. Hi Paul

    I’m a little confused on iodine supplementation. I’ve gotten to 1mg daily on empty stomach in the morning. Should I be steadily increasing from here or just stay here? Thank you


    • Hi Bob,

      Our updated recommendation is for 225 mcg/day iodine. So I would reduce supplementation, unless you have some strong therapeutic reason for taking 1 mg.

      Best, Paul

      • Hi Paul,

        Is there any page on your site with the full list of updated recommendations or views you’ve changed since PHD book was written? I’m a big fan of the book, but assume over time some of the evidence/suggestions would change. Thanks!

        • To Paul (not Jaminet, but the above commenter who is also named Paul) and to Bob,
          there is a supplements page here on this website where they list their most recent recommendations for supplements:

          However, like Paul said (Paul the above commenter), I think it would be great if they had a summary page on this site where they listed EVERY recommendation that they have changed since their last edition of the book came out.
          They wouldn’t need to explain each one in detail, just make a bullet-point list of every change in their instructions/approach, and keep it updated, so people who are interested in undertaking the diet using the most updated advice can easily do that… without having to spend a long time scrolling through different comment sections of this website trying to pick up on comments where Paul has indicated that his instruction/approach has changed from the last edition of the book.
          Maybe that sort of thing exists somewhere else — on the Facebook page maybe? I don’t use Facebook so I haven’t looked up the PHD page there. Or maybe an enthusiastic follower of the diet has a personal blog and has put together a list of the changes that have occurred after the last edition of the book was published?

  12. Oh boy I hope I didn’t do any damage supplementing that much. I must have misunderstood something I read. I’ll cut back immediately.



  13. Hi Paul,

    My mother has been swimming year-round for 90 minutes most days in an outdoor pool (heated in the winter), at a latitude similar to Boston.

    Is that too much direct sun exposure in the summer for someone of northern European descent — would it be better to wear sunscreen?

    Possibly relevant:

    (1) She stopped wearing sunscreen in the winter, and got progressively more tan as the seasons changed, but did not burn.

    (2) With that level of sun exposure in addition to about 4000 IU supplemental vitamin D, her blood levels are 40 ng/ml at the summer solstice.


    • ** for 90 minutes at noontime

    • Hi Eric,

      I think 90 minutes will be just fine as long as she gets it consistently. If she is consistent then she should tan rather than burn which is the body’s natural regulatory mechanism. If she is inconsistent then she’ll be adapted to less exposure and the 90 minutes might lead to a burn and be too much.

      However, I’m not sure she should supplement 4000 IU in addition to the sunshine. There is an open issue about whether 40 ng/ml is optimal for everyone. She might check her 1,25D and calcium levels as well to make sure they are not high in the summer.

      Best, Paul

      • Hi Paul,

        Thanks! We checked her 1,25D and calcium levels; they were:

        1,25D: 31 pg/mL (reference range 18–72 pg/mL)

        Calcium: 9.3 mg/dL (reference range 8.6–10.4 mg/dL)

        Would you say that these numbers (together with her 40 ng/ml for 25OHD) indicate that supplementing 4000 IU in addition to the sunshine is a good idea?

        Thanks again!

        • Hi Eric,

          OK, great, those are normal so that relieves concern about an inadvertent overdose. Maybe the pool water is preventing her from forming vitamin D3. I guess supplementing 4000 IU/day appears to be safe for her, though I wonder if it might become too much if her lifestyle or nutritional status changes.

          Best, Paul

  14. Hi Paul, I’ve been following the PHD for a few years now, but one problem has plagued me over the time period (unsure if cause or correlation): much worse body odor and smell/discoloring of my clothes/bed sheets.

    Basically: I smell worse more quickly (previously I could “last” all day without issue). This seems to affect the clothes I wear and my sheets — the sheets and my pillow rapidly turn yellow after a few days/weeks of use, and develop their own odor. No washing method turns them back to original color (and the difference between “my” side and the other side of the bed is striking). My clothes seem to take on this new odor as well.

    My only thought is that this could be supplement related, but I’m not sure which or how. I take your basic daily supp reccomendations: copper, iodine, magnesium, K; and then your once-weekly B- and other complex, but that’s basically it.

    • Hi Dan,

      I would try AOBiome’s Mother Dirt skin probiotic, it’s highly effective at eliminating body odor. Many odors come from nitrogen compounds derived from protein, including ammonia. The AOBiome microbes remove those. It’s possible you’ve increased protein consumption in switching to PHD.

      The other likely pathway as you’ve guessed is oversupplementation leading to excretion of mineral wastes. Be sure that copper is balanced with zinc. Don’t supplement selenium. You might stop the Bs.

      Best, Paul

    • Hi Dan,

      Are you taking probiotics? Worsening body odor happened to me when I was taking them. It was like too much bacteria for my body to handle. I didn’t have discoloring.

  15. Hi Paul,

    You often write that it’s better to supplement B vitamins sparingly because they can be growth-factors for undesirable microbes.
    You have a post about niacin, NAD and infections, I suppose that you had it in mind when you write about this precaution. However, most of the information available says the opposite: niacinamide having antimicrobial activity. Same for riboflavin, and some metabolites of other B vitamins.

    Is the confusion related to having antimicrobial activity once they are already in the body being metabolized, contrary to first coming in contact with microbes in the gut?
    If so, what about transdermal administration?

    It’s quite nice that you still answer questions after such a long time!

  16. Hi Paul,
    I am desperately hoping you can help me. My 12 yo son had a hair test with an alarming amount of cadmium and double the typical amounts of mercury and aluminum. Do you have suggestions or can you direct me to safe detoxification information? We believe this started as a result of a root canal a few years ago for a broken tooth, we just found out bacteria had grown and his root never fully formed which allowed it to became systemic.

    Thank you in advance for any help you may be able to provide

  17. Elizabeth Houser

    My 10 year old and I started a month ago.Very favorable results, so far. trying to navigate gluten free . What is our feeling about browm rice flour, at this time??

  18. Hi Paul,

    Is moon light circadian rhythm disrupting?

    Thank you,

    • Potentially yes. The question would be whether there are any benefits to having a lunar cycle of 28 days entrained by moonlight. Those might balance the disruption to the daily cycle from the full moon.

      Best, Paul

  19. Hi,

    Thank you so much for writing the book and providing this blog as a resource – it has helped guide our diet significantly! I have 2 questions:

    1. Have you guys seen any research or have any guidelines on storing/eating leftover food and whether that still retains most of its nutrients? We like to make a huge batch of salmon and eat it throughout the week, but not sure if that defeats the purpose. I’m also thinking about cutting up vegetables before the week and storing it in the fridge, so it’s easier to cook throughout the week.

    2. I’m Chinese, and we tend to eat a lot of pork. How would you rank pork among the meats – should we try to replace most of it with beef and fish instead?

    Thanks so much!

    • Hi Jenn,

      Leftover food does preserve most of its nutrients. The problem is with bacterial/microbial growth – any moldy or infected leftovers should be discarded. Smell leftover food before eating, and try to finish it within 3 days after cooking.

      Pork should be well-cooked to kill pathogens, and you should try to find a pastured pig for low omega-6 content. See the pork series, conclusion http://perfecthealthdiet.com/2012/02/the-trouble-with-pork-part-3-pathogens/, for more. A diversity of meats is a good idea, with some fish/shellfish, some birds, and some ruminants all providing useful diversification.

      Best, Paul

      • Thank you so much! That was helpful.

        Does pre cutting vegetables a few days before cooking them have any harms, e.g. Oxidation?

  20. Peter Silverman

    Since I follow a lot of the your suggestions from your book when it was self-published, I wonder if you’ve changed your mind about any of them.

  21. Hi!

    Reading your book, I notice you listed some foods on page 364, when describing the fasting practices of the Kitavens. You write that during the day, mangoes, breadfruit, bananas, and green coconut and their milk may be eaten while working.

    Does this mean that any of these foods will not break the fast during the fasting period?


  22. Hi Paul,

    Are there any problems with dry-aged beef? If it’s okay, is the outer part okay to eat as well or it should be removed?

    Thank you,

  23. Hi Paul,
    I have been on a strict PHD diet for three years. My HDL cholesterol is routinely very high at 115. Triglycerides and all other blood markers are excellent and I am in excellent physical health and active. I just read the results from a recent University of Copenhagen study which concluded that men with extremely high levels of HDL cholesterol have a 106% higher mortality rate than those with normal HDL. Should I be concerned?

    • Hi Denny,

      It’s true that optimal HDL is 70-80, and higher values can indicate inflammation evoking an immune response. However, it can also indicate that your diet is too high in fat and too low in carbs, or too high in alcohol. I would try cutting back on alcohol and fat and adding carbs, and see what HDL does.

      Best, Paul

      • Thanks for the reply. I am a light drinker and only drink occasionally hence I can rule that out as a cause of the high HDL. I am a highly competitive endurance athlete and am 53 years old. The intermittent fasting combined with 55% healthy fats have allowed me to feel great in general and perform optimally during events without need for glucose replenishment.Just wondering if perhaps the high HDL sample people in the Copenhagen study could have been heavy drinkers or had other issues which may have lead to the conclusion that HDL corresponded to increased mortality?

  24. Just discovered your book and am excited to try this new lifestyle. Question for you. I’m 5′ tall and 120lbs. Just did 30 days of keto and just didn’t feel good on it. Thinking my body needs more carbs. My goal is to lose 15lbs more pounds. . If I understood the book correctly, to avoid any malnutrition, I should consume no less than 1300 calories- 500 calories in carbs, 300 calories in protein, and 500 calories from fats? That puts my macros as: carbs-38%, protein-39%, and fat-23%. Does this sound correct? Also, Am I correct then that once I meet my weight loss goal, I would switch to the 65/15/20 macros that is more typical of the PHD?
    Thank you for your help! 😀

    • Hi Ruby,

      I think rather than thinking in terms of macros, which most people have a hard time translating correctly to food, it’s best to follow our food plate for proportions and eat to appetite. For weight loss, cut down on added fats and oils (but don’t completely eliminate them); above all reduce omega-6 fats as much as possible. For weight maintenance optimize flavor. Be sure to do intermittent fasting and tend to circadian rhythms.

      Best, Paul

      • Ok thanks. Difficult to not track macros as that’s been my way for so long. But surely will try your recommendations. Circadian is tough as I’m a night shift worker. I do IF, my last food is at 11:30 pm, and then I start eating at 3:30pm next day. Not perfect, but it’s the best I can do for now.
        I am having a tough time finishing a meal since adding some carbs after doing keto. Feeling very full/bloated. I know I need to eat more to avoid nutritional imbalance but thinking it will just take time to get used to all the extra bulk in my diet. I don’t eat gluten/pastas/breads/grains, just added potatoes/sweet potatoes back in for now.

  25. Diet and immune system bias – fungal vs bacterial vs viral

    Paul – Wonder whether you are aware of any dietary/supplement hacks which might impact immune system effectiveness on three major categories of pathogen.

    I am very vulnerable to tinea pedis and tinea versicolor on abdomen. Topical anti-fungals will knock back any outbreaks, but it always comes back. So I have a theory that my immune system is less effective on fungi.

    FWIW, I have never noticed any obvious symptoms of systemic fungal infections (Candida, etc), but the common list of symptoms for this are awfully broad and vague, so who knows. Never did any labs aimed at this, but my overall health seems quite good.

    General background is I have followed PHD principles reasonably closely for 7-8 years, and most days IF in a ~6hr window. A few times each year I go VLC/keto for periods of 1-3 weeks. Recent years no supplementation.

    Not sure if it is relevant, but I do think it is likely I have a less than optimal gut flora – a year before before going PHD and losing 22kg, I went scrupulously GF (and remain so). This change in a matter of mere days permanently transformed a Bristol Stool index from decades at 6-7 to fairly consistent 3-5, so I suspect I was true celiac rather than simply gluten intolerant. (Though never did the labs on this either.) In any case, given this history, I would think it is a fair assumption that my gut flora has retained some degree of reduced diversity or other form of dysbiosis.

    In general, do you think some people’s immune system can be biased toward/away from one or another category of pathogen, and if so, any ways to modify this?


  26. Two questions regarding safe starches: Is it ok to cook them in the microwave? Is that ‘gentle’ enough? Also, are rice cakes, like the Lundberg brand, ok or are they like ‘puffed rice’ and should not be eaten? Thank you

    • Hi Barbara,

      It’s OK to cook them in the microwave as long as you don’t dry them out. In general, flour-based products are not as healthful as natural whole foods, but you can consider them and other safe-starch flour products as acceptable but not encouraged.

      Best, Paul

    • Barbara, I think in another area of this site that Paul says he and his family eat “puffed rice” sometimes, so the Lundberg rice cakes are probably okay, but not ideal.

  27. Is Doxycycline the best antibiotic for brain infections? If so, why is it better than Tetracycline? If not, what is the best antibiotic for brain infections?

  28. Hi Paul,

    Do you think purine rich foods (like organ meats etc.) increase uric acid in the body and contribute to gout? I have heard that the main issue in gout is excess fructose consumption, not purine rich foods. What is your opinion on this?

    Thank you,

  29. HI,
    I am wondering your thoughts on mct oil?

  30. Hi Paul,
    Thanks so much for your work. I bought your book and love it. Question: I do HIIT (High Intensity Interval Training) in morning at 6:30am, typically burn about 900 calories, can I still do intermittent fasting until Noon or should I eat right after exercise? Also, if I’m 5’11”, 200 lbs do I still go with the 1 lb veg, 1 lb starch, 1 lb meat/eggs (looking to lose weight)? Thanks!

    • Hi Cian,

      Such early intense exercise is not optimal — in general intense exercise should take place in the daytime, ideally late morning or afternoon. Of course I understand it’s hard to combine optimal timing of exercise and eating with a job.

      If you must exercise so early, I’d try to move the feeding window earlier in the day, say 9 am to 3 pm, and skip dinner.

      Yes, you should stick with the same food proportions. Adjust the amounts to appetite.

      Best, Paul

  31. Dear Paul,

    You have written about ketone bodies feeding candida and so you say a ketogenic diet can make a yeast infection much worse. My yeast infection symptoms lessened with antifungal meds, and then staying on these and on my doctor’s advice I went onto a ketogenic diet and my symptoms got much worse. I believe you might be right, but my doctor is not convinced that yeasts can feed on ketone bodies. I could not find any references in your writings to studies that show yeasts can feed on ketone bodies, i.e. acetoacetate, acetone, and betahydroxybutyrate, and I have tried searching myself for such studies but could not find them. Please could you tell me which studies you are using that show that yeasts can feed on one or more of these ketone bodies?


    • Hi Simon,

      Yeasts are eukaryotes with mitochondria, therefore they are metabolically versatile and can feed on the same substrates human cells can feed on.

      However, there are also issues with a ketogenic diet suppressing anti-fungal immunity, which is glucose-dependent. That may be the more important reason why fungal infections tend to flare on very low-carb ketogenic diets. Regardless of the mechanism, there’s plenty of experience that people on low-carb or ketogenic diets are more prone to fungal infections.

      Best, Paul

      • Dear Paul,

        I am aware that there is some direct evidence of ketogenic diets inhibiting antifungal immunity. I was hoping that there was also some direct evidence of yeast infections feeding on ketone bodies.

        You have a plausible theory based on first principles. Anecdotal evidence is very important to the individuals like me from whom this evidence comes, but doesn’t otherwise count as strong evidence. This is all indirect evidence. What would be needed to confirm your theory are studies showing yeasts feeding on ketone bodies. From your answer I take it that you are not aware of any such studies or any kind of direct evidence, and without such evidence it will be difficult to convince my doctor.

        For me, your theory is the only explanation that I am aware of that explains the worsening of my symptoms on a ketogenic diet, so on that basis I believe you might be correct.

        The other area that is not clear is gut yeast infections. You have said you’re more concerned about systemic yeast infections than gut yeast infections feeding on ketone bodies, but you have not ruled this out as a problem for gut yeast infections, only saying that you are more concerned with systemic infections. Do you believe that gut yeast infections can also feed on ketone bodies where there are elevated ketone body levels generated by ketosis, even if to a lesser extent than systemic yeast infections?

        Thanks for your reply

        • Hi Simon,

          Just anecdotal, a lot of people on ketogenic diets report having problems with fungal infections. I experienced this myself as you know. I think that experience plus a plausible mechanism of action in the literature is enough for conviction. As with so much in dietary science, we have to go with the weight of the evidence, there are few certainties.

          Gut fungal infections and systemic fungal infections tend to go together. Whether or not they are the same species of fungi needs research, but it appears that having one fungal infection may make you more susceptible to others.

          The rate at which fungi can feed on ketones depends on their oxygen supply, which varies in the gut. See http://onlinelibrary.wiley.com/doi/10.1111/j.1462-5822.2010.01549.x/pdf for a discussion of how bacterial aerobic/anaerobic metabolism varies with varying oxygen levels by gut location. Something similar will occur for fungi.

          Best, Paul

  32. Should ribose and / or alcohol calories be subtracted from carb + protein calories on a ketogenic diet?

    • I don’t think so. Alcohol is not a good substitute for carbs and protein. Ribose is probably beneficial but I doubt the quantities are enough to matter. If they are enough, I’m not sure there’s data on this question.

  33. Hi Paul. I’ve been following PHD for almost two years now and thank you very much. I must say I just saw the documentary what the health, and boy do they really try and debunk animal products, dairy and eggs. The same arguments you make about grains and legumes, they make similar to red meat, saying red meat causes cancers and heart disease ect ect. They to expose all the sponsors that support cancer society, diabetes and heart association. It’s crazy, really confusing, and quite frustrating.

  34. Hello Paul,
    Depite being a large male (6ft4inches, 14.5 stone age 34) by actual RMR is only 1300 calories! according to a machine that measured my Co2.
    SO my question is… should I be eating less than 1300 calories of PHD foods to lose fat?
    (I find that idea unbearable – but need to lose fat)
    Also, I eat PHD but cannot kick sweet cravings for things like xylitol sweetened chocolote or dried fruit each day.

  35. Nicholas

    RMR is just that resting. You burn a lot more calories than that. Paul says minimum amount of calories to be well nourished is 1200. But make sure you don’t cut the carbs and protein, cut some fat instead. Best of luck

  36. Paul,
    I have followed the diet to the exact letter, and have became very insulin Resistant and developed blood sugar highs and lows that wipe me out. I am not over eating nor am I over weight, in fact I am under weight at 140 male 33 5f9in.. very active job.. I was eating 150 carbs 140g fat and enough protein. Fat from sour cream and dried coconut, and nuts eggs .. please help

    • To add I was eating 70 grams fat for each meal two meals for total 140 grams a day.. after my first meal about three hours later I am wiped out had insulin test and was very high than went low??

    • Hi Keven,

      It sounds like you are working from the 2010 edition of the book as that is about 65% of calories from fat which is more than we’ve recommended since 2012. I would cut back on oils. Also, with nuts it’s easy to get too much omega-6 fat which contributes strongly to insulin resistance. Try calculating how much omega-6 you are getting and try reducing it to 3% of total calories, no more than 72 calories or 8 g per day. I think you’ll find you are well above that.

      Then I would focus on circadian rhythm entrainment and gut health. Although you don’t need to lose weight, check out the steps in our weight loss video, those will help reduce insulin resistance while normalizing weight.

      Best, Paul

      • Paul Thank you,
        I would like to ask how would you go about that ? Is it safe to eat more than 50 carbs at a time?? I would have to up carbs a lot to add calories with out fat. Is a pound of starch at a time bad?? I use no free oil at all and I never use butter. Doc has put me on metforman because of this and I want my health back.. should I keep fasting or go to smaller meals throuout the day? What fat would you use I manly use shredded coconut and sour cream.

        • Hi Keven,

          Don’t go to smaller meals throughout the day. Do try to shift your eating window earlier in the day, and precede it with exercise and sunshine.

          Shredded coconut and sour cream are fine. Just keep the oils and the omega-6 fats down. Keep PHD proportions (see our food plate) and eat to appetite.

          Some additional things you can do:
          1. Take 2 tbsp vinegar per day along with 3 egg yolks.
          2. Optimize vitamins A and D.
          3. Get more fiber (e.g. resistant starch, vegetables, fruits)
          4. Bright white (5500 K color temperature) lighting and sunshine in the day, orange lighting at night.
          5. Try supplementing glycine, taurine, and N-acetylcysteine with extra vitamin C.

          Best, Paul

          • I just wanted to thank you for what you do and being around!! After thinking about all this and looking at where my higher fat diet had took me in the last few years I have decided to go a new route and fit into a starch based, very low fat diet to improve insulin problems (Ihope).

  37. Hi Paul
    I’ve been following the gaps gut healing protocol with my family for 2 years. My son who is 12 still has lots of eczema and allergies to air borne triggers. Your diet is very similar to gaps. We supplement with bio kult. I understand eczema is the body detox mechanism I just don’t know why my son is still reacting and not healed after 2 years. We live in north Australia so get lots of sunshine. We eat raw egg yolks, bone broth daily, (liver not at all), ferments daily. It’s driving me crazy as we have worked so hard to help him heal. What in your opinion helps eczema and allergies heal. Thanks so much.

  38. Hello Eric / Paul

    Depite being a large male (6ft4inches, 14.5 stone age 34) by actual RMR is only 1300 calories! according to a machine that measured my Co2.

    SO my question is… should I be eating less than 1300 calories of PHD foods to lose fat?

    (I find that idea unbearable – but need to lose fat)

    Also, I eat PHD but cannot kick sweet cravings for things like xylitol sweetened chocolate or dried fruit each day.


    • Hi nicholas,

      No. Eating less than 1300 calories would be dangerous for someone of your stature. And you can still lose weight while eating more calories than your RMR: You just need to eat fewer calories than you burn — which is your RMR plus the calories your burn through activity. In other words, if your RMR was 1300, you ate 1500 calories, and got 500 calories worth of physical activity, you’d still be able to lose weight (1500 < 1300 + 500 = 1800).

      To reduce calorie intake, the first step should be to eliminate all added fats and oils — use cooking methods like steaming and boiling so you don't need any cooking oil, and skim fat off of soup stock that you make. Then favor lean meats like shellfish over fatty meats like beef, and cut back on fatty plant foods like nuts and chocolate. Otherwise just eat PHD. You'll still be eating more than 1300 calories per day, but I wouldn't go lower than that.

      By the way, you should probably screen for hypothyroidism if you haven't already (have your doctor measure TSH), since that's a common cause of low RMR. If you are hypothyroid, then replacement thyroid hormone will raise your RMR and make it easier to lose weight.


      • Hi Eric, thanks for this information.
        I am happy to follow this advice, my only concern is that I struggle with brain fog / inflammation and mental exhaustion. I have read a lot of information about fats being vital for brain health and carbs increasing brain fog and blood sugar symptoms.

        Is it safe for me to cut fats and still shed the brain fog?

        Many Thanks for your help on this

        • Hi Nick,

          Eating fewer carbs could be therapeutic for some causes of brain fog; it could also make other causes of brain fog worse. So you’ll have to experiment.

          Have you screened for hypothyroidism yet? That’s a possible cause of brain fog too, which is often made worse by eating fewer carbs.

          If you don’t have hypothyroidism, then I would suggest comparing your symptoms on regular PHD to your symptoms on ketogenic PHD. (The ketogenic version of PHD is discussed in the book — basically, you reduce intake of carbs and most fats, replacing both with ketogenic fats such coconut fat.) Knowing whether ketogenic dieting makes things better or worse might help narrow down the cause.

          I would think about losing weight after you resolve the brain fog.


  39. Hello Paul,

    Still familiarising myself with the diet…

    Not very keen on liver…but could probably manage 115gs of chicken liver a week and get the rest of those nutrients from dark chocolate….yummy….

    You suggest a 200g 85% dark chocolate bar a week….

    What would a 200g 85% dark chocolate bar = in raw cocoa powder….?


  40. i have very high blood pressure and underweight. dr wants me to take atenonol for a short time to bring in down I cant sleep My cortisol kicks in and does not shut off for weeks thats what increases BP and triggers the anxiety and becomes a viscous circle I dont want to have a stroke but I also dont want to take the medicine. I eat an awful lot so getting enough calories is not the issue however the anxiety increases the metabolism just dont know what else to do

  41. Hi Paul

    What is your take on chia seeds? Are the accepted on PHD?



  42. The PHD recommendation is to avoid milk but I fail to find anywhere in the book ta explains why that is so? Can anyone point me to some scientific explanation as to why milk is to be avoided? Thanks.

  43. Hi Paul

    I know your busy but I have a very important question that I think would interest the whole PHD community. I recently saw a documentary on Netflix called sustainability. There was a local farmer that was harvesting grains from seeds way back in time, that were never altered or tampered with. They are considered old agricultural seeds. A bread company in Chicago makes all different kinds of bread and shows how new seeds and dough become bread in less than 4 hours, while the fermentation of the old seeds takes up to 60 hours. They claim the natural gluten is harmless even to celiac sufferers. Would this type of bread, going back to old fermentation methods be acceptable in today’s society? Is it just current methods that make grains unhealthy? Your opinion would be greatly appreciated


  44. Is high oleic sunflower a safe oil?

  45. Paul,
    Sorry to take your time, but as a long time PHD follower please help..
    Do you think 110 grams fat, 200 carbs, 100grams protein is safe for active 33 male? I am trying hard here to stay with PHD. Do you think those ratios are healthy r will they cause insulin resistance? About how many grams of fat per day are you personally eating now??

    • Hi Keven,

      Yes, those are fine. They will cause insulin resistance if they provide excess energy. It’s best to do intermittent fasting and eat to appetite, no more, to regulate caloric intake. I don’t know how many grams of fat I eat, I just eat with PHD proportions and do intermittent fasting.

      Best, Paul

  46. What is the best and way to raise dopamine levels?

  47. Hi Paul,

    I am apo-e4 E4E3 male age 33

    My functional doc said I should avoid alcohol like the plague for this reason. Research shows it increases Alzheimer’s early onset

    Do you agree?

    I already have slow and hard of thinking – this seems to have been made much worse since I did neurofeedback. I also have PTSD and milder OCD since childhood. Feel trapped.

    Any tips beyond food suggestions would make me very grateful


    • Nick, I am not a medical expert, but I am also an APO E4/E3 person, and I am pretty sure that having that APO combination is said to substantially increase the risk of having normal-age-onset Alzheimer’s, not early-onset Alzheimer’s.

      I think the risk of early-onset Alzheimer’s for us is not different from the typical person’s risk, so if drinking alcohol increases the risk of early-onset Alzheimer’s (I don’t know if it does or not, but if your functional doc is correct about that), it might be the case that drinking alcohol wouldn’t be more likely to cause early-onset Alzheimer’s in an APO E3/E4 person than it would in any other “random” person.

      There is an APO e4 website that has a lot of info and an active discussion board. I am not a member myself, but I’ve come across it from time to time when I have been researching different topics.

      One thing you might look into is fish oil and APO e4 — apparently, it’s been shown that fish oil doesn’t help e4 people and actually might be detrimental to them.
      (Whereas it definitely helps non-e4 people.) There haven’t been that many studies on it though.

  48. When obtaining the optimal range of carbs, should I be counting total carbs or net carbs?

  49. Hi Paul, I got Grave’s Disease or something similar with TSI antibodies after “stopping” 6.25 mg of Iodoral which I had taken for 2 1/2 years (based on 1st book). Now I’ve been having hypo/adrenal issues for past couple years. Taking 100 mcg T4, 1/2 grain NDT. My new labs show suppressed TSH. Low testosterone. High cholesterol. Low WBC. Glucose high maybe. My body doesn’t really respond to thyroid meds (I’ve taken up to 3 grains of NDT with no change in temp/pulse). I think the TSH is suppressed because my body isn’t using the meds. Do you know of anything obvious that I should do based on these labs:

    TSH: 0.05
    Free T3: 3.45 (2.50-3.90)
    Free T4: 0.95 (0.60-1.20)
    WBC: 4.0 (4.5-10.0) – Low
    Glucose Fast: 96 (70-99) – Seems High
    Cholesterol: 233 (150-200) – High
    Triglyceride: 76 (<=149)
    HDL: 70
    Non-HDL: 163 (<=130) – High
    LDL: 148 (68-100) – High
    VLDL: 15 (4-54)
    Total Testosterone: 289 (300-890) – Low

    Saliva Test:
    DHEAS: 5.5 (2-23) – Low
    Cortisol: 7.9 (3.7-9.5)-morning
    Cortisol: 2.0 (1.2-3.0)-noon
    Cortisol: 0.6 (0.6-1.9)-evening
    Cortisol: 0.8 (0.4-1.0)-night

    • Hi Steve,

      The labs don’t provide an obvious handle as to what is going on. LDL is a bit high – 130 mg/dl is optimal – I normally don’t get concerned until it reaches 150 mg/dl, but in your case since hyperthyroidism depresses LDL, the hyperthyroidism may be masking a more severe problem. The other numbers that are off are the slightly high triglycerides, low testosterone, of course the low TSH, and the slightly high fasting glucose and low WBC count. For most of those the cause or best treatment can be hard to pin down.

      The common causes of elevated LDL, apart from hypothyroidism, are modification of LDL by an endotoxemia and iron excess. So I would get iron tested and donate blood to bring iron down (ferritin should be about 50 after donation and around 100 before donation). For endotoxemia, tend to gut health with extracellular matrix and bile supports, vinegar, egg yolks, intermittent fasting, circadian rhythm entrainment, vitamin C, vitamin A and vitamin D. For testosterone, intermittent fasting and circadian rhythm entrainment are crucial, also be sure to get good proportions of protein, carbs, and saturated fats, while keeping omega-6 fats down. Zinc and copper optimization, with calcium and magnesium, should help.

      Best, Paul

      • Thanks Paul, I think your advice would stay the same, but I should have clarified that I am “hypo”-thyroid.

        I became “hyper” in 2014 for 6 months. Been “hypo” ever since.

        What terrifies me is that the TSI antibodies have never decreased, & yesterday I got my highest reading ever. Apparently the antibodies can be stimulating or blocking & could latch on to various receptors in the body. I just want to get rid of them somehow.

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